Kristen Formanek, LCSW
Individual provider Active NPI Clinical Social Worker · East Granby, CT
NPI 1114567153 · NPPES record last updated Jan 7, 2020
Key facts
- NPI
- 1114567153
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 010816 (CT)
- Practice address
- 17 Chelsea LN
East Granby, CT 06026-9635 - Phone
- (860) 543-3928
- NPI assigned
- Jan 7, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010816 | CT | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 010816 | CT | Yes |
Addresses
Primary practice location
17 Chelsea LN
East Granby, CT 06026-9635
Mailing address
17 Chelsea LN
East Granby, CT 06026-9635
Phone (860) 543-3928
Other providers in East Granby, CT
- Educational Advancement Associates
- Ellsworth Medical, LLC
- Maureen Elizabeth Emery
- Edward M Ewald
- Ellen Farmer Lanctot
- Fortify Wellness and Physical Therapy LLC
- Elizabeth S Freedman
- Khuram R Ghumman
- Robert L Gordon
- Healing Edge Medical Associates LLC
All providers in East Granby, CT · Clinical Social Worker in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.