Provider Demographics
NPI:1366800369
Name:WALWORTH, KATHERINE (MA,BA,LPC)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:WALWORTH
Suffix:
Gender:F
Credentials:MA,BA,LPC
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:WALWORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:58 RIVERS STREET
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:203-693-1050
Mailing Address - Fax:203-306-3388
Practice Address - Street 1:20 ELM ST
Practice Address - Street 2:UNIT 2
Practice Address - City:STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06378-1259
Practice Address - Country:US
Practice Address - Phone:860-303-7166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002867101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CTPENDINGOtherMULTI-PLAN
CTPENDINGOtherANTHEM BCBS OF CT BEHAVIORAL HEALTH
CT13863724OtherCAQH