Provider Demographics
NPI:1508070343
Name:RILEY, KRISTIE L (LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:L
Last Name:RILEY
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:L
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LMHC
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06088-0149
Mailing Address - Country:US
Mailing Address - Phone:860-372-5922
Mailing Address - Fax:
Practice Address - Street 1:40 DALE RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3692
Practice Address - Country:US
Practice Address - Phone:860-253-5020
Practice Address - Fax:860-253-5030
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CT001626101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health