Provider Demographics
NPI:1164446100
Name:BARTLETT, DONALD DAVID (LPC, LADC, MHC)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:DAVID
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:LPC, LADC, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 HENRY AVE APT C
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1188
Mailing Address - Country:US
Mailing Address - Phone:860-839-0820
Mailing Address - Fax:203-575-9675
Practice Address - Street 1:56 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2103
Practice Address - Country:US
Practice Address - Phone:203-755-1196
Practice Address - Fax:203-575-9675
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000386101YA0400X
NY002714101YM0800X
CT000015101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional