Healthcare Provider Details

I. General information

NPI: 1346958592
Provider Name (Legal Business Name): KRISTIN HERZIG LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 MOUNTAIN RD
SUFFIELD CT
06078-2084
US

IV. Provider business mailing address

2 JAMES ST
ENFIELD CT
06082-4018
US

V. Phone/Fax

Practice location:
  • Phone: 860-698-1150
  • Fax:
Mailing address:
  • Phone: 860-983-1618
  • 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: