Healthcare Provider Details

I. General information

NPI: 1053255166
Provider Name (Legal Business Name): KRB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1781 HIGHLAND AVE
CHESHIRE CT
06410-1254
US

IV. Provider business mailing address

1781 HIGHLAND AVE
CHESHIRE CT
06410-1254
US

V. Phone/Fax

Practice location:
  • Phone: 619-618-5387
  • Fax:
Mailing address:
  • Phone: 619-618-5387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KEMAR R BAILEY
Title or Position: CEO
Credential:
Phone: 619-618-5387