Healthcare Provider Details

I. General information

NPI: 1740526672
Provider Name (Legal Business Name): KELLY FORTIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 SPIELMAN HWY
BURLINGTON CT
06013-1723
US

IV. Provider business mailing address

231 CATLIN RD
HARWINTON CT
06791-1714
US

V. Phone/Fax

Practice location:
  • Phone: 860-351-7445
  • Fax:
Mailing address:
  • Phone: 860-368-8665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2783
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: