Provider Demographics
NPI:1992080105
Name:PRACITTO, KRISTIN HOLDT (LCSW)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:HOLDT
Last Name:PRACITTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:ELIZABETH
Other - Last Name:HOLDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:4TH FLOOR ADMINISTRATION
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:402 E MAIN ST
Practice Address - Street 2:WATERBURY OP ADULT SERVICES
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702
Practice Address - Country:US
Practice Address - Phone:203-755-1143
Practice Address - Fax:203-753-3274
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0045421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CT060669107OtherUBH/UNITED HEALTHCARE WELLMORE GRP/FACILITY
CT10450310 WATERBURYOtherBEACON HEALTH STRATEGIES
CT060669107OtherUBH/OXFORD FREEDOM/LIBERTY WELLMORE GRP/FACILITY
CT060669107OtherOPTUM BEHAVIORAL HEALTH/UBH WELLMORE GRP/FACILITY
CT060669107OtherUBH/CONNECTICARE WELLMORE GRP/FACILITY
CT574044 PENDINGOtherMHN TRICARENORTH
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CT060669107OtherAETNA BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CT574044 PENDINGOtherMHN MANAGED HEALTN NETWORK
CT13752330OtherCAQH
CT00803733Medicaid
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT13752330OtherCAQH