Provider Demographics
NPI:1710459888
Name:DEMAS, KAITLYN CECELIA
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:CECELIA
Last Name:DEMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KAITLYN
Other - Middle Name:CECELIA
Other - Last Name:WALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:97 PARK AVE UNIT 34
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-8501
Mailing Address - Country:US
Mailing Address - Phone:860-874-4968
Mailing Address - Fax:
Practice Address - Street 1:16 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4019
Practice Address - Country:US
Practice Address - Phone:203-729-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-29
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003033101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional