Healthcare Provider Details

I. General information

NPI: 1932023892
Provider Name (Legal Business Name): MARY KATHRYN MANNING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 LINWOOD ST
NEW BRITAIN CT
06052-1998
US

IV. Provider business mailing address

21 KLOCK ST
MERIDEN CT
06451-5422
US

V. Phone/Fax

Practice location:
  • Phone: 860-515-2330
  • Fax:
Mailing address:
  • Phone: 860-866-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: