Provider Demographics
NPI:1225782667
Name:BURGHARDT, KRISTIN (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BURGHARDT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 FOSTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:NY
Mailing Address - Zip Code:13778-2280
Mailing Address - Country:US
Mailing Address - Phone:607-875-5016
Mailing Address - Fax:
Practice Address - Street 1:638 SQUIRREL HILL RD
Practice Address - Street 2:
Practice Address - City:CHENANGO FORKS
Practice Address - State:NY
Practice Address - Zip Code:13746-2145
Practice Address - Country:US
Practice Address - Phone:607-656-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0755761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical