Healthcare Provider Details

I. General information

NPI: 1194573485
Provider Name (Legal Business Name): AMBER LEIGH DAOUST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 GRANT ST
HARTFORD CT
06106-4108
US

IV. Provider business mailing address

21 GRANT ST
HARTFORD CT
06106-4108
US

V. Phone/Fax

Practice location:
  • Phone: 860-550-7559
  • Fax:
Mailing address:
  • Phone: 860-550-7559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8271
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: