Provider Demographics
NPI:1710203476
Name:KRANITZ, LINDA S (PHD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:KRANITZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 WILLARD AVE
Mailing Address - Street 2:THIRD FLOOR -- SATP
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2631
Mailing Address - Country:US
Mailing Address - Phone:860-667-6736
Mailing Address - Fax:860-667-6842
Practice Address - Street 1:555 WILLARD AVE
Practice Address - Street 2:THIRD FLOOR -- SATP
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2631
Practice Address - Country:US
Practice Address - Phone:860-667-6736
Practice Address - Fax:860-667-6842
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003025103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical