Provider Demographics
NPI:1790172468
Name:KATHERINE POWELL, LCSW MPH, LLC
Entity Type:Organization
Organization Name:KATHERINE POWELL, LCSW MPH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW MPH
Authorized Official - Phone:203-942-9830
Mailing Address - Street 1:907 LIVINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:ELIZAVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12523-1022
Mailing Address - Country:US
Mailing Address - Phone:203-942-9830
Mailing Address - Fax:
Practice Address - Street 1:72 NORTH ST STE 304
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5653
Practice Address - Country:US
Practice Address - Phone:203-942-9830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT055561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty