Healthcare Provider Details

I. General information

NPI: 1831526110
Provider Name (Legal Business Name): DALE E KINGSLEY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CLARK LN UNIT A
WATERFORD CT
06385-2310
US

IV. Provider business mailing address

68 NEW SHORE RD
WATERFORD CT
06385-3635
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:
Title or Position:
Credential:
Phone: