Healthcare Provider Details

I. General information

NPI: 1922000645
Provider Name (Legal Business Name): KRISTINE STRATTON BURNS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 HIGHLAND AVE
WATERBURY CT
06708-3419
US

IV. Provider business mailing address

18 YORK ST
ANSONIA CT
06401-2130
US

V. Phone/Fax

Practice location:
  • Phone: 203-755-0270
  • Fax: 203-755-5791
Mailing address:
  • Phone: 203-732-7811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number03-182165
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: