Individual
KRISTEN SCHULTZ TASSIELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
90 SODOM LN, DERBY, CT 06418-2608
(475) 439-9639
Mailing address
90 SODOM LN, DERBY, CT 06418-2608
(475) 439-9639
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5133
CT
Other
Enumeration date
03/20/2019
Last updated
03/20/2019
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