Healthcare Provider Details

I. General information

NPI: 1447325683
Provider Name (Legal Business Name): LOUIS ANDREW DELEGAN JR. LPC MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 MANSFIELD AVE
WILLIMANTIC CT
06226-2027
US

IV. Provider business mailing address

1007 N MAIN ST
DAYVILLE CT
06241-2170
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-2261
  • Fax:
Mailing address:
  • Phone: 860-456-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1511
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: