Healthcare Provider Details

I. General information

NPI: 1245707199
Provider Name (Legal Business Name): DANIELLE DIPISA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELLE DOLAN LPC

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 FEDERAL RD STE 201 BUILDING A, SUITE 201
BROOKFIELD CT
06804-2541
US

IV. Provider business mailing address

67 FEDERAL RD STE 201
BROOKFIELD CT
06804-2541
US

V. Phone/Fax

Practice location:
  • Phone: 860-317-6005
  • Fax:
Mailing address:
  • Phone: 860-317-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3549
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: