Healthcare Provider Details

I. General information

NPI: 1952468563
Provider Name (Legal Business Name): KATHLEEN CAIRNS PSY D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 FARMINGTON AVE
W HARTFORD CT
06119
US

IV. Provider business mailing address

720 FARMINGTON AVE
W HARTFORD CT
06119
US

V. Phone/Fax

Practice location:
  • Phone: 860-286-5555
  • Fax:
Mailing address:
  • Phone: 860-286-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number002301
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number14125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: