Healthcare Provider Details

I. General information

NPI: 1518115930
Provider Name (Legal Business Name): KATHERINE L RENDE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 ALBION ST
BRIDGEPORT CT
06605-2602
US

IV. Provider business mailing address

1046 FAIRIFLED AVE
BRIDGEPORT CT
06605-1116
US

V. Phone/Fax

Practice location:
  • Phone: 203-330-6000
  • Fax: 203-330-6008
Mailing address:
  • Phone: 203-330-6054
  • Fax: 203-331-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: