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General NPI Number Information
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NPI Number | 1679202030
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Entity Type | Individual
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Provider Name | KRISTIN FERGUSON
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Gender | Female
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 2 BRIAR CLF
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City | BURLINGTON
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State | CT
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Zip | 06013-2233
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Country | US
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Telephone | 860-368-8665
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Fax |
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Provider Business Mailing Address
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Address Line | 56 WHITING ST UNIT 846
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City | PLAINVILLE
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State | CT
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Zip | 06062-7734
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Country | US
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Telephone | 860-368-8665
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 005318
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License Number State | CT
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