Healthcare Provider Details

I. General information

NPI: 1760710313
Provider Name (Legal Business Name): KRISTEN LATHROP, PSYD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MAIN ST SUITE 1008E
HARTFORD CT
06103-2703
US

IV. Provider business mailing address

750 MAIN ST SUITE 1008E
HARTFORD CT
06103-2703
US

V. Phone/Fax

Practice location:
  • Phone: 860-920-5101
  • Fax:
Mailing address:
  • Phone: 860-920-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002695
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number002695
License Number StateCT

VIII. Authorized Official

Name: KRISTEN LATHROP
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 860-920-5101