Provider Demographics
NPI:1427135581
Name:TAYLOR, KATHLEEN X (LPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:X
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 NEW BRITAIN RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-3165
Mailing Address - Country:US
Mailing Address - Phone:860-827-9364
Mailing Address - Fax:860-505-8120
Practice Address - Street 1:279 NEW BRITAIN RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-3165
Practice Address - Country:US
Practice Address - Phone:860-827-9364
Practice Address - Fax:860-505-8120
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001342101YP2500X
CT1-12-11782103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0042585448Medicaid