Individual
MR. RUSSELL T KLOTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
60 ELM ST, VERNON, CT 06066-3240
(860) 875-0292
(860) 871-4910
Mailing address
60 ELM ST, VERNON, CT 06066-3240
(860) 875-0292
(860) 871-4910
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000784
CT
Other
Enumeration date
08/18/2011
Last updated
08/18/2011
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