Doctor Name: | KATHERINE WALWORTH |
NPI Number: | 1366800369 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 002867 |
Business Practice Address: | 20 Elm St Unit 2 Stonington, CT - 063781259 |
Business Phone Number: | 8603037166 |
Business Fax Number: | |
Mailing Address: | 20 Elm St, Unit 2 STONINGTON |
State: | CT |
Postal Code: | 063781259 |
Phone Number: | 8603037166 |
Fax Number: | |
NPI Enumeration Date: | 02/04/2016 |
NPI Last Update Date: | 02/04/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 002867 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |