Provider Demographics
NPI:1700030400
Name:DEMACARTY, KATHLEEN MARY (SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARY
Last Name:DEMACARTY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 OLYMPIC DR
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-8216
Mailing Address - Country:US
Mailing Address - Phone:203-545-4550
Mailing Address - Fax:203-794-0757
Practice Address - Street 1:7 OLYMPIC DR
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-8216
Practice Address - Country:US
Practice Address - Phone:203-545-4550
Practice Address - Fax:203-794-0757
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012142-1235Z00000X
CT000517235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012142-1OtherSLP NYS LICENSE
CT000517OtherSLP CT LICENSE