Provider Demographics
NPI:1053621979
Name:CHOMICK, KRISTINA JOANNE (LMFT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:JOANNE
Last Name:CHOMICK
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41C NEW LONDON TPKE STE 4
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4209
Mailing Address - Country:US
Mailing Address - Phone:860-281-7862
Mailing Address - Fax:
Practice Address - Street 1:41C NEW LONDON TPKE STE 4
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4209
Practice Address - Country:US
Practice Address - Phone:860-281-7862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235942Medicaid