Healthcare Provider Details

I. General information

NPI: 1366952087
Provider Name (Legal Business Name): KATHLEEN ANNE PRESTON LICSW.,LADC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2017
Last Update Date: 10/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 BELMONT AVE
BRATTLEBORO VT
05301-6652
US

IV. Provider business mailing address

81 BELMONT AVE
BRATTLEBORO VT
05301-6652
US

V. Phone/Fax

Practice location:
  • Phone: 802-254-9071
  • Fax:
Mailing address:
  • Phone: 802-579-5960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number151.0126271
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0085301
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: