Provider Demographics
NPI:1124266069
Name:ASSOCIATES IN KINLEINING, INC
Entity type:Organization
Organization Name:ASSOCIATES IN KINLEINING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEDESCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-753-0868
Mailing Address - Street 1:1215 THOMASTON AVE
Mailing Address - Street 2:BLDG B
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-1731
Mailing Address - Country:US
Mailing Address - Phone:203-753-0868
Mailing Address - Fax:866-441-1136
Practice Address - Street 1:1215 THOMASTON AVE
Practice Address - Street 2:BLDG B
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-1731
Practice Address - Country:US
Practice Address - Phone:203-753-0868
Practice Address - Fax:866-441-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty