Provider Demographics
NPI:1104620368
Name:DAIGLE, CARISSA DEANNE (LAPC)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:DEANNE
Last Name:DAIGLE
Suffix:
Gender:
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SHERMANS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW BLOOMFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:17068-8547
Mailing Address - Country:US
Mailing Address - Phone:717-582-9922
Mailing Address - Fax:
Practice Address - Street 1:550 SHERMANS VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW BLOOMFIELD
Practice Address - State:PA
Practice Address - Zip Code:17068-8547
Practice Address - Country:US
Practice Address - Phone:717-275-7400
Practice Address - Fax:877-373-3818
Is Sole Proprietor?:No
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC001087101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional