Provider Demographics
NPI:1245517002
Name:MASTRIANNA, LAURIE REBECCA (LCSW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:REBECCA
Last Name:MASTRIANNA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FARMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1432
Mailing Address - Country:US
Mailing Address - Phone:203-228-9332
Mailing Address - Fax:
Practice Address - Street 1:249 WINSTED RD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-2958
Practice Address - Country:US
Practice Address - Phone:860-496-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0076871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical