Provider Demographics
NPI:1588235543
Name:DUTIL, GINA L (LPC-A)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:L
Last Name:DUTIL
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:L
Other - Last Name:DUTIL LAYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:86 BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2644
Mailing Address - Country:US
Mailing Address - Phone:203-245-0412
Mailing Address - Fax:203-612-9030
Practice Address - Street 1:86 BRADLEY RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2644
Practice Address - Country:US
Practice Address - Phone:203-245-0412
Practice Address - Fax:203-612-9030
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4735101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional