MEDICARE: MS. KRISTEN K WOLD LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	001744	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861749723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTEN K WOLD LMFT

Provider Business Mailing Address
First Line	:	304 MAIN ST STE 418
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-2985
Country	:	US
Telephone Number	:	860-595-2890
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 MAIN ST STE 418
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-2985
Country	:	US
Telephone Number	:	860-595-2890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2012
Last Update Date	:	07/21/2022

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