Provider Demographics
NPI:1457793747
Name:BARRETT, AMY KIEVIT
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KIEVIT
Last Name:BARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:KIEVIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 N MAIN ST STE 1004
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1974
Mailing Address - Country:US
Mailing Address - Phone:860-748-1012
Mailing Address - Fax:
Practice Address - Street 1:733 HILL ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-2243
Practice Address - Country:US
Practice Address - Phone:860-748-1012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-27
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT109071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical