Provider Demographics
NPI:1407993579
Name:SACCO, KRISTI A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:A
Last Name:SACCO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OLD OAK RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1830
Mailing Address - Country:US
Mailing Address - Phone:203-767-0366
Mailing Address - Fax:267-316-7428
Practice Address - Street 1:191 POST RD W
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4625
Practice Address - Country:US
Practice Address - Phone:203-767-0366
Practice Address - Fax:267-316-7428
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002537103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist