Individual
THERESA PENNACHIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
428 COLUMBUS AVENUE, CHILD FAMILY GUIDANCE, NEW HAVEN, CT 06519-1233
(203) 503-3055
(203) 503-3066
Mailing address
PO BOX 7720, CREDENTIALING SPECIALIST, NEW HAVEN, CT 06519-0720
(203) 503-3174
(203) 503-3183
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235918
—
CT
Enumeration date
01/22/2014
Last updated
03/17/2018
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