Healthcare Provider Details

I. General information

NPI: 1477836849
Provider Name (Legal Business Name): KATURAH A BRYANT RN,LMFT,LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATURAH A ABDUL-SALAAM RN,LMFT,LADC

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 SHERMAN AVE
HAMDEN CT
06514-1147
US

IV. Provider business mailing address

57 WILLIS ST
NEW HAVEN CT
06511-1740
US

V. Phone/Fax

Practice location:
  • Phone: 203-915-6301
  • Fax:
Mailing address:
  • Phone: 203-915-6301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000001
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000001
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000900
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberE36896
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberE36896
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberE36896
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: