Individual
KETSIA DESTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
80 PROSPECT ST, WATERBURY, CT 06702-1327
(203) 598-8630
Mailing address
17 MORELAND AVE, WATERBURY, CT 06705-2916
(203) 850-4322
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
05/31/2023
Last updated
05/31/2023
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