Healthcare Provider Details

I. General information

NPI: 1649996497
Provider Name (Legal Business Name): DAWN VICTORIA MASTERSON LPCA, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN VICTORIA MASTERSON-PALOMBA LPCA, LMT

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 MAIN ST UNIT 2D
MIDDLETOWN CT
06457-3375
US

IV. Provider business mailing address

55 LANTERN PARK DR APT 5
NAUGATUCK CT
06770-1871
US

V. Phone/Fax

Practice location:
  • Phone: 860-248-6046
  • Fax:
Mailing address:
  • Phone: 203-707-8301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9806
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number007904
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: