Individual
KATHRYN ELAINE ROOSEVELT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
21 CHICAGO AVE, GROTON, CT 06340-4907
(800) 526-3485
Mailing address
35 MILE CREEK RD, APT 3D, OLD LYME, CT 06371-1712
(618) 559-1124
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8260
CT
Other
Enumeration date
07/23/2013
Last updated
07/23/2013
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