Katherine Bothos, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

002950 Issued in CT

Practice address

170 Post Rd
Suite 208
Fairfield, CT 06824-6242

Phone

(203) 445-3736

NPI assigned

Nov 17, 2009

Last updated

Mar 21, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 16

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2001

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Southern Connecticut Christian Counseling CenterGroup PAC ID 9133266109, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr. Katherine Bothos LLC

  • Clinical Psychologist
  • Fairfield, CT
  • NPI 1871044388
  Medicare reassignment NPD Authorized official
• Southern Connecticut Christian Counseling Center

  dba Renew Counseling Associates

  • Community/Behavioral Health Agency
  • Fairfield, CT
  • NPI 1164652871
  Medicare reassignment Care Compare group
• Dr. Katherine Bothos, LLC

  • Clinical Psychologist
  • Fairfield, CT
  • NPI 1033438015
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1258416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490054400000",
    "number": "1114254836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 POST RD",
            "address_2": "SUITE 208",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068246242",
            "telephone_number": "203-445-3736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 POST RD",
            "address_2": "SUITE 208",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068246242",
            "telephone_number": "203-445-3736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTHOS",
        "first_name": "KATHERINE",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-11-17",
        "last_updated": "2017-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "002950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS OF CT- BOTHOS. MD",
            "identifier": "06002950CT02",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEACON HEALTH- VALUE OPTIONS   AWAKEN THE POWER THERAPY, LLC",
            "identifier": "PENDING",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY CT- AWAKEN THE POWER THERAPY, LLC",
            "identifier": "PENDING",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTUM BEHAVIORAL HEALTH- AWAKEN THE POWER THERAPY, LLC",
            "identifier": "PENDING",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12099166",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTUM BEHAVIORAL HEALTH CONNECTICARE- AWAKEN THE POWER THERAPY, LLC",
            "identifier": "PENDING",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS OF CT -AWAKEN THE POWER THERAPY, LLC",
            "identifier": "PENDING",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA BEHAVIORAL HEALTH- AWAKEN THE POWER THERAPY, LLC",
            "identifier": "PENDING",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEI BEHAVIORAL HEALTH    AWAKEN THE POWER THERAPY, LLC",
            "identifier": "PENDING",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTI-PLAN -AWAKEN THE POWER THERAPY, LLC",
            "identifier": "PENDING",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CTBPH/BEACON HEALTH VOPTIONS    BOTHS,MD",
            "identifier": "004553",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008025366",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTUM BEHAVIORAL HEALTH- UHC  AWAKEN THE POWER THERAPY, LLC",
            "identifier": "PENDING",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THREE RIVERS        AWAKEN THE POWER THERAPY, LLC",
            "identifier": "PENDING",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA BEHAVIORAL HEALTH    BOTHOS, MD",
            "identifier": "3239811",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTUM BEHAVIORAL HEALTH- OXFORD/FREEDOM  AWAKEN THE POWER THERAPY, LLC",
            "identifier": "PENDING",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Bonilla, PHYSICIAN ASSISTANT
• Kaitlyn Boorin
• Shayna Borges, OTR/L
• Jolanta Borto, PSY.D.
• Frank Michael Boskello Sr., PHD
• Nancy McGrath Bottger, LCSW, SEP
• Vicki Boudin, PSY.D.
• Alla Bourlatskii
• Corey Craig Bousquet, PA-C
• Donna M Bowers, PT

• Clinical Psychologist in Fairfield, CT
• Providers in Fairfield, CT by specialty
• Clinical Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.