Provider Demographics
NPI:1396438883
Name:DILLON, KRISTY (MSW)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:DILLON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2941
Mailing Address - Country:US
Mailing Address - Phone:203-433-2550
Mailing Address - Fax:949-404-6557
Practice Address - Street 1:420 E MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2941
Practice Address - Country:US
Practice Address - Phone:203-433-2550
Practice Address - Fax:949-404-6557
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical