Provider Demographics
NPI:1245371798
Name:KETT, LEE CALANDRA (MS)
Entity type:Individual
Prefix:MISS
First Name:LEE
Middle Name:CALANDRA
Last Name:KETT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HAWLEY ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2112
Mailing Address - Country:US
Mailing Address - Phone:203-232-5489
Mailing Address - Fax:
Practice Address - Street 1:682 PROSPECT AVE
Practice Address - Street 2:STE 101
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4238
Practice Address - Country:US
Practice Address - Phone:203-232-5489
Practice Address - Fax:860-274-0688
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health