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Individual

DAVID KETNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
15 BALABAN RD, COLCHESTER, CT 06415-1701
(860) 537-6100
Mailing address
15 BALABAN RD, COLCHESTER, CT 06415-1701

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
000172
CT
101YM0800X
Mental Health Counselor
Primary
000827
CT

Other

Enumeration date
09/09/2014
Last updated
09/09/2014
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