Provider Demographics
NPI:1245707199
Name:DIPISA, DANIELLE (LPC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DIPISA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:DOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:277 CANDLEWOOD MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-5803
Mailing Address - Country:US
Mailing Address - Phone:774-200-3214
Mailing Address - Fax:
Practice Address - Street 1:30 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3517
Practice Address - Country:US
Practice Address - Phone:774-200-3214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3549101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional