Provider Demographics
NPI:1902495963
Name:KELLY BADYRKA, LPC, LLC
Entity Type:Organization
Organization Name:KELLY BADYRKA, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:BADYRKA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-272-8520
Mailing Address - Street 1:123 FARMINGTON AVE STE 177
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 FARMINGTON AVE STE 177
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4200
Practice Address - Country:US
Practice Address - Phone:860-863-7170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health