Individual
LISA MARIE KICINSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
114 S MAIN ST STE 28AND32, CHESHIRE, CT 06410-3111
(860) 348-5614
Mailing address
114 S MAIN ST STE 28AND32, CHESHIRE, CT 06410-3111
(806) 348-5614
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
14684
CT
Other
Enumeration date
05/31/2022
Last updated
12/05/2024
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