Healthcare Provider Details

I. General information

NPI: 1578909552
Provider Name (Legal Business Name): KRISTEN L DANCE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WESTWOOD AVE
WATERBURY CT
06708-2460
US

IV. Provider business mailing address

75 WEST ST
DANBURY CT
06810-6528
US

V. Phone/Fax

Practice location:
  • Phone: 203-921-7372
  • Fax:
Mailing address:
  • Phone: 203-921-7372
  • Fax: 203-205-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2628
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: