Provider Demographics
NPI:1275890220
Name:CROTEAU, KAITLYN (MSW)
Entity Type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:
Last Name:CROTEAU
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 POST OAK RD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1830
Mailing Address - Country:US
Mailing Address - Phone:203-414-5143
Mailing Address - Fax:
Practice Address - Street 1:75 WEST ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6528
Practice Address - Country:US
Practice Address - Phone:203-726-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060888719OtherTAX ID