Provider Demographics
NPI:1215685516
Name:LOGA, KATHRYN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:LOGA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BOUND LINE RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2000
Mailing Address - Country:US
Mailing Address - Phone:203-704-7041
Mailing Address - Fax:
Practice Address - Street 1:70 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1207
Practice Address - Country:US
Practice Address - Phone:203-346-1931
Practice Address - Fax:203-346-1935
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0120121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical