Healthcare Provider Details

I. General information

NPI: 1164446100
Provider Name (Legal Business Name): DONALD DAVID BARTLETT LPC, LADC, MHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 CHURCH ST
WATERBURY CT
06702-2103
US

IV. Provider business mailing address

69 HENRY AVE APT C
PALISADES PARK NJ
07650-1188
US

V. Phone/Fax

Practice location:
  • Phone: 203-755-1196
  • Fax: 203-575-9675
Mailing address:
  • Phone: 860-839-0820
  • Fax: 203-575-9675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000386
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002714
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000015
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: