Provider Demographics
NPI:1114740578
Name:DINGUS, JAMIE ALEXANDRA
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:ALEXANDRA
Last Name:DINGUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2508
Mailing Address - Country:US
Mailing Address - Phone:203-589-7254
Mailing Address - Fax:
Practice Address - Street 1:225 N MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4993
Practice Address - Country:US
Practice Address - Phone:860-506-7905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health