Provider Demographics
NPI:1346870524
Name:HRICZ, KIMBERLY ALICIA (LPC, LADC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALICIA
Last Name:HRICZ
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1964
Mailing Address - Country:US
Mailing Address - Phone:203-892-6357
Mailing Address - Fax:203-751-9688
Practice Address - Street 1:435 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1964
Practice Address - Country:US
Practice Address - Phone:203-892-6357
Practice Address - Fax:203-751-9688
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002687101YP2500X
CT001345101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)