Healthcare Provider Details

I. General information

NPI: 1952773772
Provider Name (Legal Business Name): LICIA KRIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 SIMSBURY RD BLDG 9
AVON CT
06001-3777
US

IV. Provider business mailing address

93 VILLAGE LN
COLLINSVILLE CT
06019-3419
US

V. Phone/Fax

Practice location:
  • Phone: 860-307-5722
  • Fax:
Mailing address:
  • Phone: 860-307-5722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberC072015001831
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number007461
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: