Provider Demographics
NPI:1700135753
Name:SMITH, CRISTEN (LPC, LMHC)
Entity Type:Individual
Prefix:MS
First Name:CRISTEN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EDGEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-7828
Mailing Address - Country:US
Mailing Address - Phone:203-583-3569
Mailing Address - Fax:475-277-4989
Practice Address - Street 1:1 EDGEFIELD AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-7828
Practice Address - Country:US
Practice Address - Phone:412-848-0420
Practice Address - Fax:774-243-0597
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11416101YM0800X
PA006522101YM0800X
101YP2500X
CT5519101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional