Provider Demographics
NPI:1053522698
Name:BERUBE, JOHN D (LMFT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:BERUBE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 BUENA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1677
Mailing Address - Country:US
Mailing Address - Phone:203-374-9077
Mailing Address - Fax:
Practice Address - Street 1:61 BUENA VISTA RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-1677
Practice Address - Country:US
Practice Address - Phone:203-374-9077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000848106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist