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General NPI Number Information
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NPI Number | 1992118095
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Entity Type | Organization
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Legal Business Name | KRISTINA J. CHOMICK, LMFT - THERAPY, SUPERVISION AND CONSULTING SVCS
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 17 S HIGHLAND ST
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1826
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Country | US
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Telephone | 860-281-7862
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Fax |
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Provider Business Mailing Address
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Address Line | 17 S HIGHLAND ST
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1826
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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 | OWNER/MANAGER
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Name | KRISTINA CHOMICK
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Credential | LMFT
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Telephone | 860-281-7862
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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 | 27.001400
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License Number State | CT
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