Healthcare Provider Details

I. General information

NPI: 1437893450
Provider Name (Legal Business Name): KAROLINA A. WYTRYKOWSKA LPC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 FENN RD
NEWINGTON CT
06111-2250
US

IV. Provider business mailing address

203 STODDARD AVE # 203
NEWINGTON CT
06111-1926
US

V. Phone/Fax

Practice location:
  • Phone: 860-518-4687
  • Fax:
Mailing address:
  • Phone: 860-518-4687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1429
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5440
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: