Healthcare Provider Details

I. General information

NPI: 1265116602
Provider Name (Legal Business Name): KATELYN MATUSKA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MACDONOUGH PL
MIDDLETOWN CT
06457-3607
US

IV. Provider business mailing address

181 AUSTIN RYER LN
BRANFORD CT
06405-2670
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-3433
  • Fax:
Mailing address:
  • Phone: 203-751-1578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13108
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: