Provider Demographics
NPI:1679734222
Name:CORUJO-AIRD, EVETTE (LPC)
Entity type:Individual
Prefix:MRS
First Name:EVETTE
Middle Name:
Last Name:CORUJO-AIRD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 DEPOT STREET
Mailing Address - Street 2:SUITE 202 UNIT E
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795
Mailing Address - Country:US
Mailing Address - Phone:860-506-5200
Mailing Address - Fax:860-506-5272
Practice Address - Street 1:51 DEPOT STREET
Practice Address - Street 2:SUITE 202 UNIT E
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795
Practice Address - Country:US
Practice Address - Phone:860-506-5200
Practice Address - Fax:860-506-5272
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001031101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional