Provider Demographics
NPI:1477886174
Name:JILL R. CRISTO MA LMFT LLC
Entity Type:Organization
Organization Name:JILL R. CRISTO MA LMFT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRISTO
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT LLC
Authorized Official - Phone:860-463-6723
Mailing Address - Street 1:1100 NEW BRITAIN AVE
Mailing Address - Street 2:SUITE NUMBER 14
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-2427
Mailing Address - Country:US
Mailing Address - Phone:860-463-6723
Mailing Address - Fax:860-233-4996
Practice Address - Street 1:23 COLONIAL DR N
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2393
Practice Address - Country:US
Practice Address - Phone:860-463-6723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-12
Last Update Date:2009-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000717302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization