Provider Demographics
NPI:1861723868
Name:HYDE, KATHERINE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:HYDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-1149
Mailing Address - Country:US
Mailing Address - Phone:860-509-3626
Mailing Address - Fax:860-289-0090
Practice Address - Street 1:474 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-1149
Practice Address - Country:US
Practice Address - Phone:860-509-3626
Practice Address - Fax:860-289-0090
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2152871041C0700X
CT0081001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical