Provider Demographics
NPI:1780372458
Name:HOSP, KRISTIN L (MFT-A)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:HOSP
Suffix:
Gender:F
Credentials:MFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CLOVER HILL RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-2513
Mailing Address - Country:US
Mailing Address - Phone:203-913-1024
Mailing Address - Fax:
Practice Address - Street 1:ONE POMPERAUG OFFICE PARK RD.
Practice Address - Street 2:BUILDING ONE, SUITE103
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488
Practice Address - Country:US
Practice Address - Phone:203-558-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3077106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty