Provider Demographics
NPI:1477973667
Name:FORTUNA, KALI (LADC, MS, NCC)
Entity Type:Individual
Prefix:MS
First Name:KALI
Middle Name:
Last Name:FORTUNA
Suffix:
Gender:F
Credentials:LADC, MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3241 MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4850
Mailing Address - Country:US
Mailing Address - Phone:203-529-5250
Mailing Address - Fax:203-283-9372
Practice Address - Street 1:3241 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4850
Practice Address - Country:US
Practice Address - Phone:203-529-5250
Practice Address - Fax:203-283-9372
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-26
Last Update Date:2014-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1083101YA0400X
CT301936101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)