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General NPI Number Information
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NPI Number | 1902495963
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Entity Type | Organization
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Legal Business Name | KELLY BADYRKA, LPC, LLC
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Dates
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Enumeration Date | 01/14/2021
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 123 FARMINGTON AVE STE 177
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City | BRISTOL
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State | CT
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Zip | 06010-4200
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Country | US
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Telephone | 860-863-7170
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Fax |
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Provider Business Mailing Address
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Address Line | 123 FARMINGTON AVE STE 177
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City | BRISTOL
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State | CT
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Zip | 06010-4200
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | KELLY JENNIFER BADYRKA
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Credential | LPC
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Telephone | 860-272-8520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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