Provider Demographics
NPI:1992057772
Name:WILLOW TREATMENT & ASSOCIATES, INC.
Entity type:Organization
Organization Name:WILLOW TREATMENT & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-535-0318
Mailing Address - Street 1:60 CONNOLLY PARKWAY; BUILDING 2C-207
Mailing Address - Street 2:WILBUR CROSS COMMONS
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514
Mailing Address - Country:US
Mailing Address - Phone:203-535-0318
Mailing Address - Fax:
Practice Address - Street 1:60 CONNOLLY PARKWAY; BUILDING 2C-207
Practice Address - Street 2:WILBUR CROSS COMMONS
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514
Practice Address - Country:US
Practice Address - Phone:203-535-0318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001265102L00000X, 103TP0016X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty