Provider Demographics
NPI:1154785533
Name:BERENSON, DAYSHA (LMHC, LPC, CCC)
Entity type:Individual
Prefix:MS
First Name:DAYSHA
Middle Name:
Last Name:BERENSON
Suffix:
Gender:F
Credentials:LMHC, LPC, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6543
Mailing Address - Country:US
Mailing Address - Phone:360-933-4220
Mailing Address - Fax:
Practice Address - Street 1:189 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6543
Practice Address - Country:US
Practice Address - Phone:360-933-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
CT4670101YP2500X
WALH60967595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional