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: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10015 OLD COLUMBIA RD STE B215
COLUMBIA MD
21046-1865
US

IV. Provider business mailing address

15630 OLD COLUMBIA ROAD SUITE B 215
COLUMBIA MD
21046
US

V. Phone/Fax

Practice location:
  • Phone: 240-836-2733
  • Fax: 240-836-2756
Mailing address:
  • Phone: 204-836-2733
  • Fax: 240-836-2756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHRYN BURNETT
Title or Position: DIRECTOR & CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 240-836-2733