Provider Demographics
NPI:1780774737
Name:DUFRESNE, CONCETTA D'AGOSTINO (LMFT)
Entity type:Individual
Prefix:MRS
First Name:CONCETTA
Middle Name:D'AGOSTINO
Last Name:DUFRESNE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1686 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1279
Mailing Address - Country:US
Mailing Address - Phone:860-919-7866
Mailing Address - Fax:
Practice Address - Street 1:1686 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:CT
Practice Address - Zip Code:06085-1279
Practice Address - Country:US
Practice Address - Phone:860-919-7866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1388106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008044147Medicaid