Provider Demographics
NPI:1063698546
Name:COGNATO, KIMBERLY A (LADC, CCDP, CAC,)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:COGNATO
Suffix:
Gender:F
Credentials:LADC, CCDP, CAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2523
Mailing Address - Country:US
Mailing Address - Phone:860-362-5225
Mailing Address - Fax:888-242-2103
Practice Address - Street 1:372 DANBURY RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-2523
Practice Address - Country:US
Practice Address - Phone:860-362-5225
Practice Address - Fax:888-242-2103
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000799101YA0400X
CT001885101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008017939Medicaid
CT004123840Medicaid
CT008031626Medicaid