Healthcare Provider Details

I. General information

NPI: 1750751657
Provider Name (Legal Business Name): KRISTIN LEIGH FRUECHTENICHT M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 OSBORNE ST APARTMENT #3
DANBURY CT
06810-5918
US

IV. Provider business mailing address

11 OSBORNE ST APARTMENT #3
DANBURY CT
06810-5918
US

V. Phone/Fax

Practice location:
  • Phone: 203-733-8079
  • Fax:
Mailing address:
  • Phone: 203-733-8079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: