Provider Demographics
NPI:1154686962
Name:NOTARANGELO, KRISTY LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:LEE
Last Name:NOTARANGELO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 COURT ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1273
Mailing Address - Country:US
Mailing Address - Phone:860-632-1326
Mailing Address - Fax:860-632-1028
Practice Address - Street 1:110 COURT ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1273
Practice Address - Country:US
Practice Address - Phone:860-632-1326
Practice Address - Fax:860-632-1028
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-08
Last Update Date:2012-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0079631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical