Provider Demographics
NPI:1861550105
Name:CONNOLLY, LINDA LAFATA (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LAFATA
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1631
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-1631
Mailing Address - Country:US
Mailing Address - Phone:805-471-5723
Mailing Address - Fax:805-771-9545
Practice Address - Street 1:1030 VINE ST
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-2559
Practice Address - Country:US
Practice Address - Phone:805-237-3170
Practice Address - Fax:805-226-3107
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 36940106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist