Provider Demographics
NPI:1083207567
Name:KAITLIN MYSKA LMFT LLC
Entity Type:Organization
Organization Name:KAITLIN MYSKA LMFT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND LICENSED CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KAITLIN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MYSKA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-375-4060
Mailing Address - Street 1:12 MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:CT
Mailing Address - Zip Code:06043-7619
Mailing Address - Country:US
Mailing Address - Phone:203-312-3590
Mailing Address - Fax:
Practice Address - Street 1:99 STAFFORD RD STE B-1
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-2834
Practice Address - Country:US
Practice Address - Phone:860-375-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty