Provider Demographics
NPI:1609915297
Name:KATHLEEN E. GARNET, PH.D., LLC
Entity type:Organization
Organization Name:KATHLEEN E. GARNET, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNET
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-633-7882
Mailing Address - Street 1:381 HUBBARD ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-5307
Mailing Address - Country:US
Mailing Address - Phone:860-633-7882
Mailing Address - Fax:860-659-1999
Practice Address - Street 1:381 HUBBARD ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-5307
Practice Address - Country:US
Practice Address - Phone:860-560-6912
Practice Address - Fax:860-760-6912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2201103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT680001782Medicare ID - Type UnspecifiedPSYCHOLOGIST