Healthcare Provider Details

I. General information

NPI: 1013742659
Provider Name (Legal Business Name): MICHELLE CARMENE DELICES LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 NEW LITCHFIELD ST PH
TORRINGTON CT
06790-6609
US

IV. Provider business mailing address

310 NEW LITCHFIELD ST PH
TORRINGTON CT
06790-6609
US

V. Phone/Fax

Practice location:
  • Phone: 347-296-5355
  • Fax:
Mailing address:
  • Phone: 347-296-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number8872
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: