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General NPI Number Information
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NPI Number | 1083207567
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Entity Type | Organization
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Legal Business Name | KAITLIN MYSKA LMFT LLC
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Dates
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Enumeration Date | 02/16/2021
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 99 STAFFORD RD STE B-1
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City | ELLINGTON
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State | CT
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Zip | 06029-2834
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Country | US
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Telephone | 860-375-4060
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Fax |
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Provider Business Mailing Address
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Address Line | 12 MEADOW RD
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City | BOLTON
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State | CT
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Zip | 06043-7619
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Country | US
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Telephone | 203-312-3590
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Fax |
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Authorized Official
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Title or Position | OWNER AND LICENSED CLINICIAN
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Name | KAITLIN MARIE MYSKA
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Credential | LMFT
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Telephone | 860-375-4060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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