Provider Demographics
NPI:1477836849
Name:BRYANT, KATURAH A (RN,LMFT,LADC)
Entity Type:Individual
Prefix:MS
First Name:KATURAH
Middle Name:A
Last Name:BRYANT
Suffix:
Gender:F
Credentials:RN,LMFT,LADC
Other - Prefix:MRS
Other - First Name:KATURAH
Other - Middle Name:A
Other - Last Name:ABDUL-SALAAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,LMFT,LADC
Mailing Address - Street 1:57 WILLIS ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-1740
Mailing Address - Country:US
Mailing Address - Phone:203-915-6301
Mailing Address - Fax:
Practice Address - Street 1:830 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-1147
Practice Address - Country:US
Practice Address - Phone:203-915-6301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000001101YA0400X, 101YM0800X
CT000900106H00000X
CTE36896163W00000X, 163WA0400X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult