Provider Demographics
NPI:1225335292
Name:KOISTINEN, KARL ERIC JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:ERIC
Last Name:KOISTINEN
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 FARMINGTON AVE
Mailing Address - Street 2:123
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2162
Mailing Address - Country:US
Mailing Address - Phone:860-803-8089
Mailing Address - Fax:
Practice Address - Street 1:998 FARMINGTON AVE
Practice Address - Street 2:123
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2162
Practice Address - Country:US
Practice Address - Phone:860-803-8089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-27
Last Update Date:2011-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0052671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical