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General NPI Number Information
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NPI Number | 1871044388
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Entity Type | Organization
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Legal Business Name | DR. KATHERINE BOTHOS LLC
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 170 POST RD SUITE 208
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City | FAIRFIELD
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State | CT
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Zip | 06824-6262
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Country | US
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Telephone | 203-445-3736
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Fax |
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Provider Business Mailing Address
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Address Line | 170 POST RD SUITE 208
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City | FAIRFIELD
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State | CT
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Zip | 06824-6262
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Country | US
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Telephone | 203-445-3736
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. KATHERINE BOTHOS
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Credential | PSY.D
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Telephone | 203-445-3736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 002950
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License Number State | CT
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