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General NPI Number Information
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NPI Number | 1285383679
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Entity Type | Individual
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Provider Name | KATELYN BOUTWELL
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Gender | Female
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Dates
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Enumeration Date | 03/22/2022
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 25 PENDLETON DR
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City | HEBRON
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State | CT
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Zip | 06248-1579
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Country | US
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Telephone | 860-228-9488
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Fax |
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Provider Business Mailing Address
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Address Line | 347 BOSTON HILL RD
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City | ANDOVER
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State | CT
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Zip | 06232-1422
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 002804
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License Number State | CT
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