Individual
DR. LAURA D EBLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
95 MAIN STREET, CANAAN, CT 06018-0653
(860) 824-1350
(413) 229-3634
Mailing address
PO BOX 653, CANAAN, CT 06018-0653
(860) 824-1350
(413) 229-3634
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
001833
CT
103TC0700X
Clinical Psychologist
5062
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00415456400
—
CT
01
—
0502421
MASS HEALTH
MA
01
—
W04778
MEDICARE B
MA
Enumeration date
09/07/2006
Last updated
07/14/2010
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