Provider Demographics
NPI:1265113625
Name:SANDERS, KATHERINE MILLER (MS, LBA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MILLER
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MS, LBA
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MILLER
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:24 FAIRVIEW ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1808
Mailing Address - Country:US
Mailing Address - Phone:860-471-2694
Mailing Address - Fax:
Practice Address - Street 1:835 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2363
Practice Address - Country:US
Practice Address - Phone:860-413-9538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1679103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst