Provider Demographics
NPI:1205078268
Name:KRISTIN KOBERSTEIN, LMFT, LLC
Entity type:Organization
Organization Name:KRISTIN KOBERSTEIN, LMFT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOBERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-888-2752
Mailing Address - Street 1:200 REGAN RD
Mailing Address - Street 2:35 C
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-2850
Mailing Address - Country:US
Mailing Address - Phone:860-428-4134
Mailing Address - Fax:
Practice Address - Street 1:15 N MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1974
Practice Address - Country:US
Practice Address - Phone:860-888-2752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001242106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT419475OtherMHN
CT4100001242CT01OtherANTHEM
CT9890123OtherAETNA