Provider Demographics
NPI:1063198257
Name:BARTLETT, KEVIN DAVIS
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:DAVIS
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MURRAY ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-3407
Mailing Address - Country:US
Mailing Address - Phone:860-608-3603
Mailing Address - Fax:
Practice Address - Street 1:109 MURRAY ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-3407
Practice Address - Country:US
Practice Address - Phone:860-608-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor