Mackinnon, Crystal
Mackinnon, Crystal is an individual health care provider with primary practice located at 428 Long Hill Rd Ste 201 , Groton CT 06340-3811. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Mackinnon, Crystal can be contacted via phone (860) 333-8765.Contact Information
Primary practice address
428 Long Hill Rd Ste 201
Groton CT 06340-3811
Phone: (860) 333-8765
Fax: (833) 204-4896
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 008709 | Connecticut |
Profile Details
| NPI number | 1275812372 |
|---|---|
| LBN Legal business name | Mackinnon, Crystal |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 8th, 2011 |
| Last updated | Mar 5th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275812372 | NPPES |
| Connecticut | MEDICAID | 040400564 |
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