| Dr. Katherine Bothos Llc | |
|
170 Post Rd Suite 208 Fairfield CT 06824-6262 | |
| (203) 445-3736 | |
| Not Available |
| Full Name | Dr. Katherine Bothos Llc |
|---|---|
| Speciality | Psychologist |
| Location | 170 Post Rd, Fairfield, Connecticut |
| Authorized Official Name and Position | Katherine Bothos (LICENSED CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 2034453736 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Katherine Bothos Llc 170 Post Rd Suite 208 Fairfield CT 06824-6262 Ph: (203) 445-3736 | Dr. Katherine Bothos Llc 170 Post Rd Suite 208 Fairfield CT 06824-6262 Ph: (203) 445-3736 |
| NPI Number | 1871044388 |
|---|---|
| Provider Enumeration Date | 10/19/2016 |
| Last Update Date | 10/19/2016 |
| Medicare PECOS PAC ID | 1759642861 |
|---|---|
| Medicare Enrollment ID | O20180307000666 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871044388 | NPI | - | NPPES |
| 008025366 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 002950 (Connecticut) | Primary |
| Provider Name | Katherine Bothos |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1114254836 PECOS PAC ID: 6204197312 Enrollment ID: I20180307000748 |
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