Provider Demographics
NPI:1043580137
Name:WORLEY, KATIE (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:WORLEY
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1746 HARTFORD NEW LONDON TPKE
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:OAKDALE
Mailing Address - State:CT
Mailing Address - Zip Code:06370-1756
Mailing Address - Country:US
Mailing Address - Phone:315-885-3906
Mailing Address - Fax:
Practice Address - Street 1:567 VAUXHALL STREET EXT
Practice Address - Street 2:SUITE #207
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4330
Practice Address - Country:US
Practice Address - Phone:860-245-1321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist