Healthcare Provider Details

I. General information

NPI: 1871479915
Provider Name (Legal Business Name): KRISTIN PARDUE MFT-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ENTERPRISE DR STE 415
SHELTON CT
06484-4631
US

IV. Provider business mailing address

8 WAKEMAN RD
FAIRFIELD CT
06824-5120
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-5078
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3670
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: