Doctor Name: | KRISTA NORDMARK |
NPI Number: | 1003136854 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 587 E Middle Tpke Manchester, CT - 060403731 |
Business Phone Number: | 8606463888 |
Business Fax Number: | 8606454132 |
Mailing Address: | 587 E Middle Tpke, MANCHESTER |
State: | CT |
Postal Code: | 060403731 |
Phone Number: | 8606463888 |
Fax Number: | 8606454132 |
NPI Enumeration Date: | 06/03/2010 |
NPI Last Update Date: | 06/03/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |