Healthcare Provider Details

I. General information

NPI: 1386420222
Provider Name (Legal Business Name): KATHRYN BURNETT, PSYD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15630 OLD COLUMBIA PIKE SUITE E # 323
BURTONSVILLE MD
20866
US

IV. Provider business mailing address

15630 OLD COLUMBIA PIKE SUITE E # 323
BURTONSVILLE MD
20866
US

V. Phone/Fax

Practice location:
  • Phone: 240-855-6585
  • Fax: 240-836-2756
Mailing address:
  • Phone: 240-855-6585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHRYN BURNETT
Title or Position: DIRECTOR & CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 240-855-6585