Healthcare Provider Details

I. General information

NPI: 1104581602
Provider Name (Legal Business Name): JENNIFER DAIGLE LPC-A, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WARNER RD
BRIDGEWATER CT
06752-1420
US

IV. Provider business mailing address

137 DANBURY RD # 191
NEW MILFORD CT
06776-3428
US

V. Phone/Fax

Practice location:
  • Phone: 860-951-8127
  • Fax:
Mailing address:
  • Phone: 860-951-8127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4671
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: