Healthcare Provider Details

I. General information

NPI: 1215050141
Provider Name (Legal Business Name): DANA DECILLIS MA, LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA TOMASSI MA, LMHC, LPC

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 NAEK ROAD
VERNON CT
06066
US

IV. Provider business mailing address

25 SOUTH VIEW DRIVE
SOUTHWICK MA
01077
US

V. Phone/Fax

Practice location:
  • Phone: 413-537-4284
  • Fax:
Mailing address:
  • Phone: 413-537-4284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5595
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1596
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: