Provider Demographics
NPI:1518598754
Name:AMATO, KRISTA (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:AMATO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GARRY DR
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-1205
Mailing Address - Country:US
Mailing Address - Phone:203-410-8538
Mailing Address - Fax:
Practice Address - Street 1:2960 POST RD STE 3B2
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-1268
Practice Address - Country:US
Practice Address - Phone:203-939-7462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT109281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical