Provider Demographics
NPI:1396815833
Name:TKACZ, KATHRYN MARY (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MARY
Last Name:TKACZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:MARY
Other - Last Name:ALWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-2084
Mailing Address - Country:US
Mailing Address - Phone:860-254-5582
Mailing Address - Fax:
Practice Address - Street 1:133 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-2084
Practice Address - Country:US
Practice Address - Phone:860-254-5582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist