Healthcare Provider Details

I. General information

NPI: 1710376629
Provider Name (Legal Business Name): TRINITY THERAPEUTIC CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CLARK LN UNIT A
WATERFORD CT
06385-2310
US

IV. Provider business mailing address

12 CLARK LN UNIT A
WATERFORD CT
06385-2310
US

V. Phone/Fax

Practice location:
  • Phone: 860-705-3668
  • Fax: 860-405-1113
Mailing address:
  • Phone: 860-705-3668
  • Fax: 860-405-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001607
License Number StateCT

VIII. Authorized Official

Name: DALE E KINGSLEY
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LMFT
Phone: 860-705-3668