MEDICARE: KACEY ELIZABETH FRIEDMAN LPC

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	101YM0800X	Mental Health Counselor	9767	CT

General Provider Information

NPI Number	:	1427730258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KACEY ELIZABETH FRIEDMAN LPC

Provider Business Mailing Address
First Line	:	61 S MAIN ST STE 209
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06107-2403
Country	:	US
Telephone Number	:	860-251-9617
Fax Number	:

Provider Business Practice Location Address
First Line	:	61 S MAIN ST STE 209
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06107-2403
Country	:	US
Telephone Number	:	860-251-9617
Fax Number	:

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

Provider Enumeration Date	:	08/02/2023
Last Update Date	:	06/04/2026

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