Provider Demographics
NPI:1134289788
Name:VAILLANCOURT, KATE (PSYD)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:VAILLANCOURT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:AIREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:2299 WOODBURY AVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7854
Mailing Address - Country:US
Mailing Address - Phone:978-572-0703
Mailing Address - Fax:
Practice Address - Street 1:2299 WOODBURY AVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-7854
Practice Address - Country:US
Practice Address - Phone:978-572-0703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NH1344103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No174400000XOther Service ProvidersSpecialist