Healthcare Provider Details

I. General information

NPI: 1730667114
Provider Name (Legal Business Name): CATHERINE M LUCKHARDT PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 12/02/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MILL ST STE 206
BURLINGTON VT
05401-1534
US

IV. Provider business mailing address

1 MILL ST STE 206
BURLINGTON VT
05401-1534
US

V. Phone/Fax

Practice location:
  • Phone: 802-448-2028
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number048.0134289
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number048.0134289
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: