Healthcare Provider Details

I. General information

NPI: 1629335666
Provider Name (Legal Business Name): KATHLEEN DENISE BARTKUS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 HIGHLAND AVE
CHESHIRE CT
06410-2527
US

IV. Provider business mailing address

141 E MAIN ST
WATERBURY CT
06702-2310
US

V. Phone/Fax

Practice location:
  • Phone: 203-599-1492
  • Fax:
Mailing address:
  • Phone: 203-598-1297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10760
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: