Provider Demographics
NPI:1487715272
Name:KAGEL, CAROL M (EDD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:M
Last Name:KAGEL
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-2084
Mailing Address - Country:US
Mailing Address - Phone:860-668-4342
Mailing Address - Fax:
Practice Address - Street 1:133 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-2084
Practice Address - Country:US
Practice Address - Phone:860-668-4342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1269103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
125102OtherVALUE OPTIONS
C0009465OtherCHAMPUS
HAS229OtherOXFORD HEALTH PLANS
CT0600001269CT01OtherANTHEMBLUE CROSSBLUESHIEL
48293OtherCIGNA BEHAVIORAL HEALTH
CT620000267Medicare ID - Type Unspecified