Healthcare Provider Details

I. General information

NPI: 1649811266
Provider Name (Legal Business Name): DANA LYN ERRICHETTI M.S.S.W, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 MAIN ST STE 122
MONROE CT
06468-2872
US

IV. Provider business mailing address

51 SHERMAN AVE
TRUMBULL CT
06611-2334
US

V. Phone/Fax

Practice location:
  • Phone: 203-261-7090
  • Fax:
Mailing address:
  • Phone: 203-895-7231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10777
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: