Provider Demographics
NPI:1861905226
Name:KYNE, ERICA (LMSW)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:KYNE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 NEWTON RD
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-5214
Mailing Address - Country:US
Mailing Address - Phone:203-530-7120
Mailing Address - Fax:
Practice Address - Street 1:263 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2326
Practice Address - Country:US
Practice Address - Phone:860-395-6380
Practice Address - Fax:203-397-9077
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CT119301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor