Provider Demographics
NPI:1063929453
Name:STIEBEL, KRISTA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:LYNN
Last Name:STIEBEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06013-2503
Mailing Address - Country:US
Mailing Address - Phone:860-882-2008
Mailing Address - Fax:
Practice Address - Street 1:152 SIMSBURY ROAD
Practice Address - Street 2:BUILDING #9
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-882-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-07
Last Update Date:2018-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0065061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical