Individual
KATHRYN LAROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
695 TALCOTTVILLE RD APT 38G, VERNON, CT 06066-2349
(860) 455-3265
Mailing address
695 TALCOTTVILLE RD APT 38G, VERNON, CT 06066-2349
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
188407721
DRIVER LICENSE
CT
Enumeration date
02/11/2019
Last updated
02/11/2019
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