Provider Demographics
NPI:1689193161
Name:TORRES-BACON, KIMBERLY L (LMFT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:TORRES-BACON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 HOBSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-7312
Mailing Address - Country:US
Mailing Address - Phone:860-880-2230
Mailing Address - Fax:
Practice Address - Street 1:209 MAIN ST STE 1-A
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2539
Practice Address - Country:US
Practice Address - Phone:860-880-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001919106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist