Provider Demographics
NPI:1487956272
Name:KATKAVICH, JONAS F (MED PSYD)
Entity type:Individual
Prefix:DR
First Name:JONAS
Middle Name:F
Last Name:KATKAVICH
Suffix:
Gender:M
Credentials:MED PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2961
Mailing Address - Country:US
Mailing Address - Phone:508-740-6230
Mailing Address - Fax:
Practice Address - Street 1:318 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2961
Practice Address - Country:US
Practice Address - Phone:508-740-6230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002918103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical