Provider Demographics
NPI:1447359062
Name:KRALL, JAMES H (LCSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:KRALL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06247
Mailing Address - Country:US
Mailing Address - Phone:860-972-3709
Mailing Address - Fax:860-465-9848
Practice Address - Street 1:33 STATION RD
Practice Address - Street 2:PO BOX 92
Practice Address - City:HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06247
Practice Address - Country:US
Practice Address - Phone:860-942-3709
Practice Address - Fax:860-465-9848
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0007981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
C007612OtherTRICARE
P895485OtherOXFORD
CT079509OtherMHN
134141OtherVALUE OPTIONS
2333070003OtherMAGELLAN
4232172OtherAETNA
CT140000798CT01OtherANTHEM
CT004255057Medicaid