Provider Demographics
NPI:1710425087
Name:FARAONI, JUAN III (PSYAD, LPC, LMHC)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:FARAONI
Suffix:III
Gender:M
Credentials:PSYAD, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 EDGEMERE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1003
Mailing Address - Country:US
Mailing Address - Phone:617-908-1228
Mailing Address - Fax:
Practice Address - Street 1:660 PROSPECT AVE STE 301
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4230
Practice Address - Country:US
Practice Address - Phone:860-400-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20181101YM0800X
MA11153101YM0800X
CT3078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health