Provider Demographics
NPI:1902998560
Name:TRUEBLOOD, PAULETTE KAY (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:KAY
Last Name:TRUEBLOOD
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MISS
Other - First Name:PAULETTE
Other - Middle Name:KAY
Other - Last Name:CASTONGUAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1230 S PINE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6352
Mailing Address - Country:US
Mailing Address - Phone:203-255-2022
Mailing Address - Fax:203-255-2512
Practice Address - Street 1:101 HARBOR RD
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-1316
Practice Address - Country:US
Practice Address - Phone:203-254-8262
Practice Address - Fax:203-255-2512
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000786106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist