Provider Demographics
NPI:1578245809
Name:LUNA, RISTA B (LPCA)
Entity Type:Individual
Prefix:
First Name:RISTA
Middle Name:B
Last Name:LUNA
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FORTY ACRE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-3359
Mailing Address - Country:US
Mailing Address - Phone:203-417-6992
Mailing Address - Fax:
Practice Address - Street 1:111 CHURCH HILL RD STE 306
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1172
Practice Address - Country:US
Practice Address - Phone:203-417-6992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional