Healthcare Provider Details

I. General information

NPI: 1265076012
Provider Name (Legal Business Name): DIEGO ARMANDO PERALTA-CALDERON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 MAIN ST
NEW BRITAIN CT
06051-4204
US

IV. Provider business mailing address

233 MAIN ST
NEW BRITAIN CT
06051-4204
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-8192
  • Fax: 860-224-6968
Mailing address:
  • Phone: 860-224-8192
  • Fax: 860-224-6968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5852
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: