Healthcare Provider Details

I. General information

NPI: 1164000477
Provider Name (Legal Business Name): COURTNEY DELLDONNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date: 03/25/2025
Reactivation Date: 04/08/2025

III. Provider practice location address

123 LOWREY PL
NEWINGTON CT
06111-3003
US

IV. Provider business mailing address

123 LOWREY PL
NEWINGTON CT
06111-3003
US

V. Phone/Fax

Practice location:
  • Phone: 860-233-3033
  • Fax:
Mailing address:
  • Phone: 860-233-3033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB605272
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB605272
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: