Healthcare Provider Details

I. General information

NPI: 1780774737
Provider Name (Legal Business Name): CONCETTA D'AGOSTINO DUFRESNE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/15/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1686 FARMINGTON AVE
UNIONVILLE CT
06085-1279
US

IV. Provider business mailing address

1686 FARMINGTON AVE
UNIONVILLE CT
06085-1279
US

V. Phone/Fax

Practice location:
  • Phone: 860-919-7866
  • Fax:
Mailing address:
  • Phone: 860-919-7866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1388
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: