Provider Demographics
NPI:1932655933
Name:HANEWICZ, KRYSTLE MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:MARIE
Last Name:HANEWICZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 ISAIAH SMITH LANE
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:CT
Mailing Address - Zip Code:06763-1506
Mailing Address - Country:US
Mailing Address - Phone:860-459-4115
Mailing Address - Fax:860-733-0323
Practice Address - Street 1:94 ISAIAH SMITH LANE
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:CT
Practice Address - Zip Code:06763-1506
Practice Address - Country:US
Practice Address - Phone:860-459-4115
Practice Address - Fax:860-733-0323
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT2484106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program