MEDICARE: KRISTI R VARISCO L.P.C.

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	101YP2500X	Professional Counselor	001791	CT

General Provider Information

NPI Number	:	1457590093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI R VARISCO L.P.C.

Provider Business Mailing Address
First Line	:	28 SUMMIT ST
Second Line	:
City	:	STONINGTON
State	:	CT
Zip	:	06378-1113
Country	:	US
Telephone Number	:	401-741-7130
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 MAIN ST
Second Line	:	SUITE 10-11
City	:	MYSTIC
State	:	CT
Zip	:	06355-3654
Country	:	US
Telephone Number	:	401-741-7130
Fax Number	:

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

Provider Enumeration Date	:	02/04/2009
Last Update Date	:	03/21/2014

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