Mallory Rose Devona, MS, NCC, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

2789 Issued in CT

Practice address

2 Leary Dr
Waterford, CT 06385

Phone

(860) 857-4769

NPI assigned

Jul 15, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mia Vita Counseling LLC

  • Counselor
  • New Haven, CT
  • NPI 1215413505
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532822400000",
    "number": "1861876211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 LEARY DR",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063853707",
            "telephone_number": "860-857-4769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 LEARY DR",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "06385",
            "telephone_number": "860-857-4769"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "47 Town St",
            "address_purpose": "LOCATION",
            "city": "Norwich",
            "state": "CT",
            "postal_code": "063602323",
            "country_code": "US",
            "telephone_number": "860-892-7042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEVONA",
        "first_name": "MALLORY",
        "middle_name": "ROSE",
        "name_prefix": "Ms.",
        "credential": "MS, NCC, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-15",
        "last_updated": "2018-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "CT",
            "license": "2789",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008060321",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Colleen Davis
• Jonathan Dean, LMFT
• Frank R. Dellacono, M.D.
• Brittany Desantis
• Anthony Devlin, HIS
• Aurora Clark Dibner, D.M.D
• Clarisse G Dicandia, PSYD
• Katelyn Dillon, M.S., CCC-SLP
• Linda Dipesa, LCSW
• Doc Eye LLC

• Counselor in Waterford, CT
• Providers in Waterford, CT by specialty
• Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.