Provider Demographics
NPI:1114207289
Name:KATHLEEN CARIUS, APRN
Entity Type:Organization
Organization Name:KATHLEEN CARIUS, APRN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARIUS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-375-8050
Mailing Address - Street 1:1129 ESSEX PL
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-5867
Mailing Address - Country:US
Mailing Address - Phone:203-375-8050
Mailing Address - Fax:
Practice Address - Street 1:1129 ESSEX PL
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5867
Practice Address - Country:US
Practice Address - Phone:203-375-8050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003880163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty