Kettavong Counseling, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

KETTAVONG COUNSELING, LLC

Practice address

18 Oneco St
Suite 3
Norwich, CT 06360-3440

Phone

(860) 822-3208

NPI assigned

Jun 17, 2016

Organization subpart

No

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

Authorized official

Name

Malyna KettavongNPI 1922435676

Title

Owner

Phone

(860) 803-9724

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Malyna Kettavong, LCSW

  • Clinical Social Worker
  • Norwich, CT
  • NPI 1922435676
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1466121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502668800000",
    "number": "1285084517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 ONECO ST",
            "address_2": "SUITE 3",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063603440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 ONECO ST",
            "address_2": "SUITE 3",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063603440",
            "telephone_number": "860-822-3208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETTAVONG COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-17",
        "last_updated": "2017-08-14",
        "status": "A",
        "authorized_official_last_name": "KETTAVONG",
        "authorized_official_first_name": "MALYNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-803-9724"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Kemp, APRN
• Danielle Kempesta, APRN
• Katelin M Kennedy
• Nickeita Kennedy
• Florabeth Kenyon
• Malyna Kettavong, LCSW
• Khalifeh Counseling, LLC
• Amna Khan, MD
• Mary L. Kilcomons, PT
• Mary Kilmer

• Clinical Social Worker in Norwich, CT
• Providers in Norwich, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.