Provider Demographics
NPI:1346578358
Name:PAINE, KATHLEEN (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PAINE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 KRUSCH DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05464-4400
Mailing Address - Country:US
Mailing Address - Phone:802-393-3382
Mailing Address - Fax:844-203-6133
Practice Address - Street 1:6 FAIRFIELD HILL RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9767
Practice Address - Country:US
Practice Address - Phone:802-393-3382
Practice Address - Fax:844-203-6133
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00011911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1346578358Medicaid
VT1346578358Medicaid