Provider Demographics
NPI:1336737048
Name:EGOZCUE, KENIA ESTHER (LPC)
Entity Type:Individual
Prefix:
First Name:KENIA
Middle Name:ESTHER
Last Name:EGOZCUE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 CATHERINE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-2074
Mailing Address - Country:US
Mailing Address - Phone:860-770-9141
Mailing Address - Fax:
Practice Address - Street 1:12 CURTIS ST STE 21
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-5900
Practice Address - Country:US
Practice Address - Phone:203-409-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4713101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional