Provider Demographics
NPI:1609388867
Name:SMITH, KAITLIN E (LCSW)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:E
Other - Last Name:PAGEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2389 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4617
Mailing Address - Country:US
Mailing Address - Phone:860-629-0107
Mailing Address - Fax:860-613-6297
Practice Address - Street 1:2389 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4617
Practice Address - Country:US
Practice Address - Phone:860-629-0107
Practice Address - Fax:860-613-6297
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CT116261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health