Provider Demographics
NPI:1538419965
Name:NUGENT, KATHLEEN E (LPC,MA,BS)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:E
Last Name:NUGENT
Suffix:
Gender:F
Credentials:LPC,MA,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:4TH FLOOR ADMINISTRATION
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:402 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1701
Practice Address - Country:US
Practice Address - Phone:203-755-1143
Practice Address - Fax:203-753-3274
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2747101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060669107OtherANTHEM BC BS OF CT WELLMORE GRP/FACILITY
CT060669107OtherUBH- CONNECTICARE WELLMORE GRP/FACILITY
CTPENDINGOtherMHN TRICARE NORTH
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CT13549351OtherCAQH
CTD339210 WATERBURYOtherBEACON HEALTH STRATEGIES
CT008058806Medicaid
CT060669107OtherUNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CT060669107OtherUBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY
CT060669107OtherUBH-LIBERTY/FREEDOM OXFORD HEALTH WELLMORE GRP/FACILITY
CTPENDINGOtherMANAGED HEALTH NETWORK
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT008058806Medicaid