MEDICARE: KENNETH PRATT LMSW

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	104100000X	Social Worker	9004	CT

General Provider Information

NPI Number	:	1861214322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH PRATT LMSW

Provider Business Mailing Address
First Line	:	34 JEROME AVE STE 203A
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-2467
Country	:	US
Telephone Number	:	860-952-3335
Fax Number	:	860-787-5517

Provider Business Practice Location Address
First Line	:	34 JEROME AVE STE 203A
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-2467
Country	:	US
Telephone Number	:	860-952-3335
Fax Number	:	860-787-5517

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

Provider Enumeration Date	:	10/28/2024
Last Update Date	:	10/28/2024

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Directions to “ KENNETH PRATT LMSW” Practice Location

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