Individual
MS. MALLORY ROSE DEVONA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, NCC, LPC
Contact information
Practice address
2 LEARY DR, WATERFORD, CT 06385
(860) 857-4769
Mailing address
2 LEARY DR, WATERFORD, CT 06385-3707
(860) 857-4769
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2789
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008060321
—
CT
Enumeration date
07/15/2015
Last updated
07/29/2018
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