Provider Demographics
NPI:1164000477
Name:DELLDONNA, COURTNEY
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:DELLDONNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 LOWREY PL
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-3003
Mailing Address - Country:US
Mailing Address - Phone:860-233-3033
Mailing Address - Fax:
Practice Address - Street 1:123 LOWREY PL
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3003
Practice Address - Country:US
Practice Address - Phone:860-233-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2025-04-08
Deactivation Date:2025-03-25
Deactivation Code:
Reactivation Date:2025-04-08
Provider Licenses
StateLicense IDTaxonomies
CTBACB605272106S00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician