Provider Demographics
NPI:1235356106
Name:BERTHIAUME, KATHRYN E (LMHC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:BERTHIAUME
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1905
Mailing Address - Country:US
Mailing Address - Phone:413-733-3488
Mailing Address - Fax:413-731-7381
Practice Address - Street 1:2257 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1905
Practice Address - Country:US
Practice Address - Phone:413-733-3488
Practice Address - Fax:413-731-7381
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YP2500X
MA6029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional