Basic Information
| Provider Information | |||||||||
| NPI: | 1649811266 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERRICHETTI | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | LYN | ||||||||
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| Credential: | M.S.S.W, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51 SHERMAN AVE | ||||||||
| Address2: | |||||||||
| City: | TRUMBULL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066112334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038957231 | ||||||||
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| Practice Location | |||||||||
| Address1: | 731 MAIN ST STE 122 | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064682872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032617090 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2019 | ||||||||
| LastUpdateDate: | 10/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 10777 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.