Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 5563 | CT |
NPI | 1811573439 |
---|---|
Provider Name | Krista Lockyer |
First Address | Somers, CT 06071-2243 |
Second Address | Manchester, CT 06040-4131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2021 |
Last Update Date | 23/03/2021 |