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General NPI Number Information
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NPI Number | 1255733911
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Entity Type | Organization
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Legal Business Name | KATHERINE BURDICK
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 340 BROAD ST SUITE 300
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City | WINDSOR
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State | CT
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Zip | 06095-3030
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Country | US
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Telephone | 860-748-5441
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Fax |
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Provider Business Mailing Address
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Address Line | 340 BROAD ST SUITE 300
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City | WINDSOR
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State | CT
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Zip | 06095-3030
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | KATHERINE BURDICK
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Credential | LMFT
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Telephone | 860-748-5441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001537
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License Number State | CT
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