Provider Demographics
NPI:1992118095
Name:KRISTINA J. CHOMICK, LMFT - THERAPY, SUPERVISION AND CONSULTING SVCS
Entity type:Organization
Organization Name:KRISTINA J. CHOMICK, LMFT - THERAPY, SUPERVISION AND CONSULTING SVCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOMICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-281-7862
Mailing Address - Street 1:17 S HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 S HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1826
Practice Address - Country:US
Practice Address - Phone:860-281-7862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT27.001400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty