Provider Demographics
NPI:1225246028
Name:SLEIGHT, KENNETH ROLAND (THM)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ROLAND
Last Name:SLEIGHT
Suffix:
Gender:M
Credentials:THM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1923
Mailing Address - Country:US
Mailing Address - Phone:860-521-8405
Mailing Address - Fax:
Practice Address - Street 1:69 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1923
Practice Address - Country:US
Practice Address - Phone:860-521-8405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional