Healthcare Provider Details

I. General information

NPI: 1295650356
Provider Name (Legal Business Name): EMILIE MARIE DUBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 FARMINGTON AVE
BERLIN CT
06037
US

IV. Provider business mailing address

75 OVERLOOK AVE
BRISTOL CT
06010-7931
US

V. Phone/Fax

Practice location:
  • Phone: 860-385-3768
  • Fax:
Mailing address:
  • Phone: 860-385-3768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9046
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: