Provider Demographics
NPI:1528700804
Name:HALL, DALTON ROMEO (LPCA)
Entity type:Individual
Prefix:
First Name:DALTON
Middle Name:ROMEO
Last Name:HALL
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4932
Mailing Address - Country:US
Mailing Address - Phone:216-389-6810
Mailing Address - Fax:
Practice Address - Street 1:31 UNION ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-3126
Practice Address - Country:US
Practice Address - Phone:860-872-5254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional