Provider Demographics
NPI:1518751403
Name:BRITTO-SEBASTIAN, KIE'ANDRA
Entity type:Individual
Prefix:
First Name:KIE'ANDRA
Middle Name:
Last Name:BRITTO-SEBASTIAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 FANNING RD
Mailing Address - Street 2:
Mailing Address - City:MASHANTUCKET
Mailing Address - State:CT
Mailing Address - Zip Code:06338-3810
Mailing Address - Country:US
Mailing Address - Phone:860-547-0748
Mailing Address - Fax:
Practice Address - Street 1:102 STONINGTON RD APT B308
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-4886
Practice Address - Country:US
Practice Address - Phone:860-574-0748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician