Healthcare Provider Details

I. General information

NPI: 1376484832
Provider Name (Legal Business Name): DIZNEY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 BITTERSWEET LANE
BERLIN CT
06037
US

IV. Provider business mailing address

26 BITTERSWEET LANE
BERLIN CT
06037
US

V. Phone/Fax

Practice location:
  • Phone: 203-314-0179
  • Fax:
Mailing address:
  • Phone: 203-314-0179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY BRUNN DIZNEY
Title or Position: OWNER-APRN/FNP
Credential: KN, MSN, APRN
Phone: 203-314-0179