Provider Demographics
NPI:1396994455
Name:MISHRIKY, KIMBERLY PATTERSON (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:PATTERSON
Last Name:MISHRIKY
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 1:10 CANDLELIGHT DR
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2537
Mailing Address - Country:US
Mailing Address - Phone:860-633-3595
Mailing Address - Fax:
Practice Address - Street 1:15 MERCER AVE
Practice Address - Street 2:SCHOOL BASED HEALTH CENTER
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1517
Practice Address - Country:US
Practice Address - Phone:860-622-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006850OtherSTATE LICENCE