Healthcare Provider Details

I. General information

NPI: 1023939022
Provider Name (Legal Business Name): LISSA MARIE PIMENTEL MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISSA DIAZ MS/LPCA

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MAIN ST STE 3
TORRINGTON CT
06790-5330
US

IV. Provider business mailing address

14 ORCHARD HILL RD
CANTON CT
06019-2129
US

V. Phone/Fax

Practice location:
  • Phone: 860-921-7761
  • Fax:
Mailing address:
  • Phone: 860-921-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9098
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: