Provider Demographics
NPI:1639504202
Name:FENNER, KAITLYN MARIE (MWS)
Entity Type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:MARIE
Last Name:FENNER
Suffix:
Gender:F
Credentials:MWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PHOENIX ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5416
Mailing Address - Country:US
Mailing Address - Phone:860-614-4777
Mailing Address - Fax:
Practice Address - Street 1:12 PHOENIX ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5416
Practice Address - Country:US
Practice Address - Phone:860-614-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker