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General NPI Number Information
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NPI Number | 1659700912
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Entity Type | Organization
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Legal Business Name | KATHRYN FALLIN, M.S.
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 3 MAIN ST STE. 216
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City | BURLINGTON
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State | VT
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Zip | 05401-5216
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Country | US
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Telephone | 802-651-7514
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Fax | 802-860-1234
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Provider Business Mailing Address
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Address Line | 11 CEDAR GLN N
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-7334
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Country | US
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Telephone | 802-578-9728
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST MASTER
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Name | KATHRYN S FALLIN
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Credential | M.S.
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Telephone | 802-651-7514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 047.0093667
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License Number State | VT
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