Provider Demographics
NPI:1447813886
Name:OCCHIONERO, KAITLYN (LCSW)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:OCCHIONERO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W THAMES ST BLDG 301
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-7155
Mailing Address - Country:US
Mailing Address - Phone:860-859-4500
Mailing Address - Fax:
Practice Address - Street 1:401 W THAMES ST BLDG 301
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-7155
Practice Address - Country:US
Practice Address - Phone:860-859-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0096371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical