MEDICARE: KATHRYN BURNETT, PSYD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TA0700X	Adult Development & Aging Psychologist
2	103TC0700X	Clinical Psychologist
3	103TC2200X	Clinical Child & Adolescent Psychologist
4	103TE1100X	Exercise & Sports Psychologist
5	103TH0004X	Health Psychologist
6	103TB0200X	Cognitive & Behavioral Psychologist

General Provider Information

NPI Number	:	1386420222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHRYN BURNETT, PSYD LLC

Provider Business Mailing Address
First Line	:	15630 OLD COLUMBIA PIKE
Second Line	:	SUITE E # 323
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866
Country	:	US
Telephone Number	:	240-855-6585
Fax Number	:

Provider Business Practice Location Address
First Line	:	15630 OLD COLUMBIA PIKE
Second Line	:	SUITE E # 323
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866
Country	:	US
Telephone Number	:	240-855-6585
Fax Number	:	240-836-2756

Authorized Official
Title or Position	:	DIRECTOR & CLINICAL PSYCHOLOGIST
Name	:	DR. KATHRYN BURNETT
Credential	:	PSYD
Telephone Number	:	240-855-6585

Provider Enumeration Date	:	09/06/2023
Last Update Date	:	09/06/2023

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