Individual
MRS. DANIELLE LAUREN FORMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19 TOPAZ LN, TRUMBULL, CT 06611-3211
(203) 610-0754
Mailing address
19 TOPAZ LN, TRUMBULL, CT 06611-3211
(032) 610-0754
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4881
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/26/2018
Last updated
05/16/2021
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