Healthcare Provider Details

I. General information

NPI: 1356886014
Provider Name (Legal Business Name): KATHRYN GELINAS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 W MAIN ST STE 2G
WATERBURY CT
06708-1444
US

IV. Provider business mailing address

969 W MAIN ST STE 2G
WATERBURY CT
06708-1444
US

V. Phone/Fax

Practice location:
  • Phone: 203-697-8983
  • Fax: 203-437-8347
Mailing address:
  • Phone: 203-697-8983
  • Fax: 203-437-8347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3103
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: