Provider Demographics
NPI:1457086423
Name:TERNULLO, DANIELLE (LADC, LPCA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:TERNULLO
Suffix:
Gender:F
Credentials:LADC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 ROCK RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06013-1615
Mailing Address - Country:US
Mailing Address - Phone:860-882-3331
Mailing Address - Fax:
Practice Address - Street 1:97 ROCK RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06013-1615
Practice Address - Country:US
Practice Address - Phone:860-882-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001454101YA0400X
CT004976101YM0800X
CT006098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)