Provider Demographics
NPI:1285095810
Name:KATHRYN ALLEN THERAPIES LLC
Entity type:Organization
Organization Name:KATHRYN ALLEN THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-508-5133
Mailing Address - Street 1:10 CROSSROADS PLZ
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2470
Mailing Address - Country:US
Mailing Address - Phone:860-508-5133
Mailing Address - Fax:860-231-7033
Practice Address - Street 1:10 CROSSROADS PLZ
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2470
Practice Address - Country:US
Practice Address - Phone:860-508-5133
Practice Address - Fax:860-231-7033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008062738Medicaid