Individual
KATELYN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
445 WILLARD AVE BLDG 2A, NEWINGTON, CT 06111-2318
(860) 798-8409
Mailing address
36 SELMA AVE, DERBY, CT 06418-2231
(860) 748-5264
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1925
CT
Other
Enumeration date
07/30/2024
Last updated
07/30/2024
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