Provider Demographics
NPI:1013251925
Name:KISTLER, JANE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:KISTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-3501
Mailing Address - Country:US
Mailing Address - Phone:203-644-0332
Mailing Address - Fax:203-834-1408
Practice Address - Street 1:120 POST RD W
Practice Address - Street 2:SUITE 102A
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4206
Practice Address - Country:US
Practice Address - Phone:203-644-0332
Practice Address - Fax:203-834-1408
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0092741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical