Healthcare Provider Details

I. General information

NPI: 1780338996
Provider Name (Legal Business Name): JULIANNE RENEE KIVLIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BRENDI TRL
COLUMBIA CT
06237-1401
US

IV. Provider business mailing address

10 BRENDI TRL
COLUMBIA CT
06237-1401
US

V. Phone/Fax

Practice location:
  • Phone: 860-428-4129
  • Fax:
Mailing address:
  • Phone: 860-428-4129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15828
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: