Healthcare Provider Details

I. General information

NPI: 1497877575
Provider Name (Legal Business Name): KATHLEEN CAROLYN WAWRZYNIAK WEBB PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 DALE RD SUITE 212
AVON CT
06001-3659
US

IV. Provider business mailing address

34 DALE RD SUITE 212
AVON CT
06001-3659
US

V. Phone/Fax

Practice location:
  • Phone: 860-878-2028
  • Fax:
Mailing address:
  • Phone: 860-878-2028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3003
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3003
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3003
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number3003
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: