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General NPI Number Information
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NPI Number | 1467566653
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Entity Type | Individual
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Provider Name | KATHLEEN MARY BURNSPOWER MED LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 198 RUSSELL ST
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City | WORCESTER
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State | MA
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Zip | 01609-2200
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Country | US
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Telephone | 508-363-4544
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Fax | 508-753-5100
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Provider Business Mailing Address
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Address Line | 5 VIKING TER
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City | WORCESTER
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State | MA
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Zip | 01604-1428
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Country | US
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Telephone | 508-438-5580
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 829
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License Number State | MA
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