Provider Demographics
NPI:1750751657
Name:FRUECHTENICHT, KRISTIN LEIGH (MS)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEIGH
Last Name:FRUECHTENICHT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OSBORNE ST
Mailing Address - Street 2:APARTMENT #3
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5918
Mailing Address - Country:US
Mailing Address - Phone:203-733-8079
Mailing Address - Fax:
Practice Address - Street 1:11 OSBORNE ST
Practice Address - Street 2:APARTMENT #3
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5918
Practice Address - Country:US
Practice Address - Phone:203-733-8079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional