Provider Demographics
NPI:1942827753
Name:KRISKEY, JERI HAKER (MA, MFTA)
Entity Type:Individual
Prefix:MRS
First Name:JERI
Middle Name:HAKER
Last Name:KRISKEY
Suffix:
Gender:F
Credentials:MA, MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 MERRITT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1533
Mailing Address - Country:US
Mailing Address - Phone:518-944-7479
Mailing Address - Fax:
Practice Address - Street 1:22 LONG RIDGE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-3812
Practice Address - Country:US
Practice Address - Phone:203-323-8560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2426106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist