Individual
CRYSTAL MACKINNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
428 LONG HILL RD STE 201, GROTON, CT 06340-3811
(860) 333-8765
(833) 204-4896
Mailing address
428 LONG HILL RD STE 201, GROTON, CT 06340-3811
(860) 333-8765
(833) 204-4896
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
008709
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040400564
—
CT
Enumeration date
08/08/2011
Last updated
03/05/2021
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