Provider Demographics
NPI:1215050141
Name:DECILLIS, DANA (MA, LMHC, LPC)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:
Last Name:DECILLIS
Suffix:
Gender:F
Credentials:MA, LMHC, LPC
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:TOMASSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC, LPC
Mailing Address - Street 1:25 SOUTH VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077
Mailing Address - Country:US
Mailing Address - Phone:413-537-4284
Mailing Address - Fax:
Practice Address - Street 1:27 NAEK ROAD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066
Practice Address - Country:US
Practice Address - Phone:413-537-4284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1596101YP2500X
MA5595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300881Medicaid
MA0300010OtherMBHP