Dr. Katherine Bothos LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

002950 Issued in CT

Legal business name

DR. KATHERINE BOTHOS LLC

Practice address

170 Post Rd
Suite 208
Fairfield, CT 06824-6262

Phone

(203) 445-3736

NPI assigned

Oct 19, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Katherine Bothos, PSY.DNPI 1114254836

Title

Licensed Clinical Psychologist

Phone

(203) 445-3736

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Tax ID family

Dr Katherine Bothos LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Dr. Katherine Bothos, LLC

  • Clinical Psychologist
  • Fairfield, CT
  • NPI 1033438015
  NPD tax ID

Locations

Practitioners 1

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

• Katherine Bothos, PSY.D

  • Clinical Psychologist
  • Fairfield, CT
  • NPI 1114254836
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476835200000",
    "number": "1871044388",
    "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": "068246262",
            "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": "068246262",
            "telephone_number": "203-445-3736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. KATHERINE BOTHOS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-19",
        "last_updated": "2016-10-19",
        "status": "A",
        "authorized_official_last_name": "BOTHOS",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_title_or_position": "LICENSED CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "203-445-3736",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "002950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008025366",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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 Oct 19, 2016; 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.