Provider Demographics
NPI:1770608010
Name:KRAWCZYK, T LYNN (LMFT)
Entity type:Individual
Prefix:
First Name:T
Middle Name:LYNN
Last Name:KRAWCZYK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 SOUTHFORD RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-3234
Mailing Address - Country:US
Mailing Address - Phone:203-758-2400
Mailing Address - Fax:203-758-2415
Practice Address - Street 1:984 SOUTHFORD RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-3234
Practice Address - Country:US
Practice Address - Phone:203-758-2400
Practice Address - Fax:203-758-2415
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000893106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT268127000OtherMAGELLAN
CT281193OtherMANAGED HEALTH NETWORK
CT410000893CT03OtherANTHEM BLUE CARD
CT410000893CT03OtherANTHEM BEHAVIORAL HEALTH
CT737708000OtherMBC CORPORATION
CT2040187OtherCIGNA
CT2040187OtherCIGNA BEHAVIORAL HEALTH
CT247582OtherAETNA
CT459952OtherVALUE OPTIONS
CT004214962Medicaid
CT281193OtherHEALTH MANAGEMENT SYSTEM
CT410000893CT03OtherANTHEM NATIONAL ACCOUNTS
CT410000893CT03OtherANTHEM FEDERAL ACCOUNTS