=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679710164
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN A DAIGLE LADC, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2009
-----------------------------------------------------
Last Update Date | 04/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 913 NEW HARWINTON RD
-----------------------------------------------------
City | TORRINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06790-5932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-309-7262
-----------------------------------------------------
Fax | 860-485-9375
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 913 NEW HARWINTON RD
-----------------------------------------------------
City | TORRINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06790-5932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-309-7262
-----------------------------------------------------
Fax | 860-485-9375
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 782
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 3168
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------