Healthcare Provider Details

I. General information

NPI: 1740193077
Provider Name (Legal Business Name): DOVE FORENSIC & CLINICAL CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 W MAIN ST
WATERBURY CT
06708-2764
US

IV. Provider business mailing address

434 N MAIN ST APT 6
MANCHESTER CT
06042-1957
US

V. Phone/Fax

Practice location:
  • Phone: 860-328-5620
  • Fax:
Mailing address:
  • Phone: 860-328-5620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMANI IMANI DOVE
Title or Position: THERAPIST
Credential: LCSW
Phone: 860-328-5620