Healthcare Provider Details

I. General information

NPI: 1912159120
Provider Name (Legal Business Name): KRISTEN HAMMEL KOWATS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 YORK ST SUITE 2H
NEW HAVEN CT
06511-5620
US

IV. Provider business mailing address

100 YORK ST SUITE 2H
NEW HAVEN CT
06511-5620
US

V. Phone/Fax

Practice location:
  • Phone: 203-764-7258
  • Fax: 203-764-7258
Mailing address:
  • Phone: 203-764-7258
  • Fax: 203-764-7258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006614
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: