Provider Demographics
NPI:1104581602
Name:DAIGLE, JENNIFER (LPC-A, NCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:LPC-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 DANBURY RD # 191
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3428
Mailing Address - Country:US
Mailing Address - Phone:860-951-8127
Mailing Address - Fax:
Practice Address - Street 1:7 WARNER RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:CT
Practice Address - Zip Code:06752-1420
Practice Address - Country:US
Practice Address - Phone:860-951-8127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4671101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional