Provider Demographics
NPI:1730193236
Name:KREUTTER, KAROLE J (PHD)
Entity type:Individual
Prefix:DR
First Name:KAROLE
Middle Name:J
Last Name:KREUTTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 BARNES RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-6012
Mailing Address - Country:US
Mailing Address - Phone:203-294-0094
Mailing Address - Fax:
Practice Address - Street 1:1062 BARNES RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-6012
Practice Address - Country:US
Practice Address - Phone:203-294-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001073103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060001073CT01Medicare UPIN
CT188180Medicare UPIN