Provider Demographics
NPI:1558007880
Name:COSGROVE, KRIS ANNE (CTR, CAWS, CDP)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:ANNE
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:CTR, CAWS, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PECK RD STE 2102
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6123
Mailing Address - Country:US
Mailing Address - Phone:860-201-4474
Mailing Address - Fax:
Practice Address - Street 1:30 PECK RD STE 2102
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6123
Practice Address - Country:US
Practice Address - Phone:860-201-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101Y00000X, 225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor