Provider Demographics
NPI:1033438015
Name:DR. KATHERINE BOTHOS, LLC
Entity Type:Organization
Organization Name:DR. KATHERINE BOTHOS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTHOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-838-8344
Mailing Address - Street 1:704 THORME ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4022
Mailing Address - Country:US
Mailing Address - Phone:203-838-8344
Mailing Address - Fax:
Practice Address - Street 1:170 POST RD STE 208
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6242
Practice Address - Country:US
Practice Address - Phone:203-455-3736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-29
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002950103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty