Provider Demographics
NPI:1013519719
Name:LIEB, KATELYN J (ND)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:J
Last Name:LIEB
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 BOSTON POST RD STE 2&3
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06498-2171
Mailing Address - Country:US
Mailing Address - Phone:860-661-5824
Mailing Address - Fax:
Practice Address - Street 1:47 OAK ST STE 290
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5320
Practice Address - Country:US
Practice Address - Phone:203-703-9033
Practice Address - Fax:475-268-1002
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5.000673175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty