Healthcare Provider Details

I. General information

NPI: 1932071750
Provider Name (Legal Business Name): DANIELLE E. JACOVINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 S MAIN ST STE 2
CHESHIRE CT
06410-3171
US

IV. Provider business mailing address

4 EVERITT LN
OAKVILLE CT
06779-2214
US

V. Phone/Fax

Practice location:
  • Phone: 203-587-3742
  • Fax:
Mailing address:
  • Phone: 860-534-1819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9840
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: