Provider Demographics
NPI:1265447148
Name:KUMPF, KRISTINE (LADC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:KUMPF
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:MARIE
Other - Last Name:KUMPF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LADC
Mailing Address - Street 1:9 MOTT AVE
Mailing Address - Street 2:FAMILY & CHILDREN'S AGENCY 4TH FLOOR
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3330
Mailing Address - Country:US
Mailing Address - Phone:203-855-8765
Mailing Address - Fax:203-838-3325
Practice Address - Street 1:9 MOTT AVE
Practice Address - Street 2:FAMILY & CHILDREN'S AGENCY 4TH FLOOR
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3330
Practice Address - Country:US
Practice Address - Phone:203-855-8765
Practice Address - Fax:203-838-3325
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000182101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT300000182CT01OtherANTHEM PROVIDER #