1114254836 NPI number — DR. KATHERINE BOTHOS PSY.D

Table of content: DR. KATHERINE BOTHOS PSY.D (NPI 1114254836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114254836 NPI number — DR. KATHERINE BOTHOS PSY.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOTHOS
Provider First Name:
KATHERINE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114254836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
170 POST RD
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06824-6242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-445-3736
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 POST RD
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06824-6242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-445-3736
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  002950 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008025366 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: PENDING . This is a "BEACON HEALTH- VALUE OPTIONS AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "OPTUM BEHAVIORAL HEALTH- UHC AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06002950CT02 . This is a "ANTHEM BCBS OF CT- BOTHOS. MD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "ANTHEM BCBS OF CT -AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "OPTUM BEHAVIORAL HEALTH- OXFORD/FREEDOM AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "FEI BEHAVIORAL HEALTH AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "OPTUM BEHAVIORAL HEALTH- AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 3239811 . This is a "CIGNA BEHAVIORAL HEALTH BOTHOS, MD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "MULTI-PLAN -AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "OPTUM BEHAVIORAL HEALTH CONNECTICARE- AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 12099166 . This is a "CAQH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "CIGNA BEHAVIORAL HEALTH- AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "HEALTHY CT- AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004553 . This is a "CTBPH/BEACON HEALTH VOPTIONS BOTHS,MD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "THREE RIVERS AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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