Provider Demographics
NPI:1265741821
Name:DUTKO, MICHAEL (LPC,LADC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:DUTKO
Suffix:
Gender:M
Credentials:LPC,LADC
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:DUTKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:230 FROST RD
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-2154
Mailing Address - Country:US
Mailing Address - Phone:203-819-0789
Mailing Address - Fax:
Practice Address - Street 1:230 FROST RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-2154
Practice Address - Country:US
Practice Address - Phone:203-819-0789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000844101YA0400X
CT002151101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)