Healthcare Provider Details

I. General information

NPI: 1558840603
Provider Name (Legal Business Name): KATHLEEN SUSAN HULL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W THAMES ST BLDG 301
NORWICH CT
06360-7155
US

IV. Provider business mailing address

28 LEE RD
LISBON CT
06351-3015
US

V. Phone/Fax

Practice location:
  • Phone: 860-859-4596
  • Fax:
Mailing address:
  • Phone: 860-367-5343
  • Fax: 888-492-8998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9956
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: