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General NPI Number Information
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NPI Number | 1265539258
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Entity Type | Individual
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Provider Name | STACIA LYNNE DILORETO LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 10/14/2009
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Provider Practice Location Address
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Address Line | 384 MERROW RD STE D
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City | TOLLAND
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State | CT
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Zip | 06084-3957
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Country | US
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Telephone | 860-796-8003
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1081
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City | MANCHESTER
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State | CT
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Zip | 06045-1081
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Country | US
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Telephone | 860-796-8003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000978
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License Number State | CT
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