Healthcare Provider Details

I. General information

NPI: 1215669338
Provider Name (Legal Business Name): KASSIDY DRENNEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 LINWOOD ST
NEW BRITAIN CT
06052-1949
US

IV. Provider business mailing address

37 HERITAGE LN
EAST HARTFORD CT
06118-3346
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-9113
  • Fax:
Mailing address:
  • Phone: 860-918-0586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3455
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: