Provider Demographics
NPI:1093320582
Name:FORTIER, KRISTIN RHEA
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:RHEA
Last Name:FORTIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 POLLACK RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1625
Mailing Address - Country:US
Mailing Address - Phone:860-368-1791
Mailing Address - Fax:
Practice Address - Street 1:9 POLLACK RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1625
Practice Address - Country:US
Practice Address - Phone:860-368-1791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CTRBT-19-107572103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst