Provider Demographics
NPI:1396402152
Name:CACECI, KRISTINA LYN (LCSW, MED)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:LYN
Last Name:CACECI
Suffix:
Gender:F
Credentials:LCSW, MED
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:CACECI
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, M ED
Mailing Address - Street 1:512 CHESTNUT TREE HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-1956
Mailing Address - Country:US
Mailing Address - Phone:203-586-9956
Mailing Address - Fax:
Practice Address - Street 1:512 CHESTNUT TREE HILL RD
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-1956
Practice Address - Country:US
Practice Address - Phone:203-586-9956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0106401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical