Provider Demographics
NPI:1407235070
Name:SALVIOLI, KRISTA MARIE (MAS, CAS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:MARIE
Last Name:SALVIOLI
Suffix:
Gender:F
Credentials:MAS, CAS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1375
Mailing Address - Country:US
Mailing Address - Phone:203-540-5186
Mailing Address - Fax:
Practice Address - Street 1:333 BENNETT ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-1375
Practice Address - Country:US
Practice Address - Phone:203-540-5186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002750101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002750OtherCONNECTICUT LICENSED PROFESSIONAL COUNSELOR