Provider Demographics
NPI:1811246234
Name:CRAIG, KATIE LYNN (MS)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:CRAIG
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 1:101 SOUTH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1967
Mailing Address - Country:US
Mailing Address - Phone:860-681-7025
Mailing Address - Fax:
Practice Address - Street 1:24 PENNY CORNER RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1625
Practice Address - Country:US
Practice Address - Phone:860-681-4153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1365103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst