Healthcare Provider Details

I. General information

NPI: 1396225991
Provider Name (Legal Business Name): BRANDON GEORGE DALENA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 BARNES RD STE 107
WALLINGFORD CT
06492-6013
US

IV. Provider business mailing address

1062 BARNES RD STE 107
WALLINGFORD CT
06492-6013
US

V. Phone/Fax

Practice location:
  • Phone: 860-364-8353
  • Fax:
Mailing address:
  • Phone: 860-364-8353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9608
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: