Healthcare Provider Details

I. General information

NPI: 1417865395
Provider Name (Legal Business Name): BRITTANY DESANTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 VAUXHALL STREET EXT STE 122
WATERFORD CT
06385-4332
US

IV. Provider business mailing address

7 COREY LN
NIANTIC CT
06357-1303
US

V. Phone/Fax

Practice location:
  • Phone: 860-917-0790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: