=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356886014
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHRYN GELINAS LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2017
-----------------------------------------------------
Last Update Date | 08/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 969 W MAIN ST STE 2G
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06708-1444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-697-8983
-----------------------------------------------------
Fax | 203-437-8347
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 969 W MAIN ST STE 2G
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06708-1444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-697-8983
-----------------------------------------------------
Fax | 203-437-8347
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 3103
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------