MEDICARE: KATIE LYNN CRAIG MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1365	CT

General Provider Information

NPI Number	:	1811246234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE LYNN CRAIG MS

Provider Business Mailing Address
First Line	:	101 SOUTH ST FL 2
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06110-1967
Country	:	US
Telephone Number	:	860-681-7025
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 PENNY CORNER RD
Second Line	:
City	:	PORTLAND
State	:	CT
Zip	:	06480-1625
Country	:	US
Telephone Number	:	860-681-4153
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	01/31/2022

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