Provider Demographics
NPI:1114254836
Name:BOTHOS, KATHERINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:BOTHOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 POST RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6242
Mailing Address - Country:US
Mailing Address - Phone:203-445-3736
Mailing Address - Fax:
Practice Address - Street 1:170 POST RD
Practice Address - Street 2:SUITE 208
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6242
Practice Address - Country:US
Practice Address - Phone:203-445-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002950103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008025366Medicaid
CTPENDINGOtherBEACON HEALTH- VALUE OPTIONS AWAKEN THE POWER THERAPY, LLC
CTPENDINGOtherOPTUM BEHAVIORAL HEALTH- UHC AWAKEN THE POWER THERAPY, LLC
CT06002950CT02OtherANTHEM BCBS OF CT- BOTHOS. MD
CTPENDINGOtherANTHEM BCBS OF CT -AWAKEN THE POWER THERAPY, LLC
CTPENDINGOtherOPTUM BEHAVIORAL HEALTH- OXFORD/FREEDOM AWAKEN THE POWER THERAPY, LLC
CTPENDINGOtherFEI BEHAVIORAL HEALTH AWAKEN THE POWER THERAPY, LLC
CTPENDINGOtherOPTUM BEHAVIORAL HEALTH- AWAKEN THE POWER THERAPY, LLC
CT3239811OtherCIGNA BEHAVIORAL HEALTH BOTHOS, MD
CTPENDINGOtherMULTI-PLAN -AWAKEN THE POWER THERAPY, LLC
CTPENDINGOtherOPTUM BEHAVIORAL HEALTH CONNECTICARE- AWAKEN THE POWER THERAPY, LLC
CT12099166OtherCAQH
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH- AWAKEN THE POWER THERAPY, LLC
CTPENDINGOtherHEALTHY CT- AWAKEN THE POWER THERAPY, LLC
CT004553OtherCTBPH/BEACON HEALTH VOPTIONS BOTHS,MD
CTPENDINGOtherTHREE RIVERS AWAKEN THE POWER THERAPY, LLC
CTPENDINGMedicare PIN