Provider Demographics
NPI:1821515578
Name:RANMAL, KATRINA
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:RANMAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 BOSTON POST RD STE 32A
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1370
Mailing Address - Country:US
Mailing Address - Phone:203-208-8996
Mailing Address - Fax:203-204-1381
Practice Address - Street 1:2614 BOSTON POST RD STE 32A
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-1370
Practice Address - Country:US
Practice Address - Phone:203-208-8996
Practice Address - Fax:203-204-1381
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002393101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional