Provider Demographics
NPI:1275252033
Name:KATHERINE GOETZ LICSW LLC
Entity Type:Organization
Organization Name:KATHERINE GOETZ LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOETZ
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-397-4331
Mailing Address - Street 1:99 NEWARK ST
Mailing Address - Street 2:
Mailing Address - City:WEST BURKE
Mailing Address - State:VT
Mailing Address - Zip Code:05871-9715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99 NEWARK ST
Practice Address - Street 2:
Practice Address - City:WEST BURKE
Practice Address - State:VT
Practice Address - Zip Code:05871-9715
Practice Address - Country:US
Practice Address - Phone:802-397-4331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health