MEDICARE: KRYSTAL CECILIO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	14062	CT

General Provider Information

NPI Number	:	1184465288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL CECILIO LCSW

Provider Business Mailing Address
First Line	:	305 BOSTON AVE
Second Line	:
City	:	STRATFORD
State	:	CT
Zip	:	06614-5256
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 BOSTON AVE
Second Line	:
City	:	STRATFORD
State	:	CT
Zip	:	06614-5256
Country	:	US
Telephone Number	:	475-422-6527
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	06/03/2024

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