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General NPI Number Information
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NPI Number | 1992931695
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Entity Type | Individual
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Provider Name | COLLEEN M DIBELLA LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 05/17/2019
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Provider Practice Location Address
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Address Line | 10 N MAIN ST STE 300
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City | WEST HARTFORD
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State | CT
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Zip | 06107-1901
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Country | US
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Telephone | 860-662-1641
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Fax | 860-760-6585
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Provider Business Mailing Address
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Address Line | 8 BRIGHTON RD
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City | WEST HARTFORD
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State | CT
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Zip | 06117-2609
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Country | US
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Telephone | 860-662-1641
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Fax | 860-760-6585
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 003954
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License Number State | CT
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