Healthcare Provider Details

I. General information

NPI: 1831763077
Provider Name (Legal Business Name): KATE E MATTHEWS LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST # 3
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

13 WEST RD
BURLINGTON VT
05408-2402
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4563
  • Fax: 802-847-7998
Mailing address:
  • Phone: 717-398-4048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0134218
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: