Healthcare Provider Details

I. General information

NPI: 1114341211
Provider Name (Legal Business Name): ELISA KLEPACKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 ALBANY AVE
HARTFORD CT
06105-1001
US

IV. Provider business mailing address

15 SEA GREEN DR
BERLIN CT
06037-4087
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-4511
  • Fax:
Mailing address:
  • Phone: 860-841-4824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: