Healthcare Provider Details

I. General information

NPI: 1275447682
Provider Name (Legal Business Name): AYSIS MACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MILL PLAIN RD
DANBURY CT
06811-5178
US

IV. Provider business mailing address

21B BECKERLE ST
DANBURY CT
06811-4607
US

V. Phone/Fax

Practice location:
  • Phone: 203-800-9778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9867
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: