Provider Demographics
NPI:1295073922
Name:VICENTE, KATHERINE IRIS
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:IRIS
Last Name:VICENTE
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 1:75 TREAT RD
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3363
Mailing Address - Country:US
Mailing Address - Phone:860-985-6317
Mailing Address - Fax:
Practice Address - Street 1:75 TREAT RD
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-3363
Practice Address - Country:US
Practice Address - Phone:860-985-6317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health