Provider Demographics
NPI:1821855925
Name:DEST, DANIELLE MICHELE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MICHELE
Last Name:DEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PLATT FARM RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:CT
Mailing Address - Zip Code:06763-1814
Mailing Address - Country:US
Mailing Address - Phone:860-689-5114
Mailing Address - Fax:
Practice Address - Street 1:802 FEDERAL RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-4008
Practice Address - Country:US
Practice Address - Phone:203-947-1191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1857103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst