Provider Demographics
NPI:1417064684
Name:ALBERT, KATHLEEN M (PHD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:ALBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:65 MIDDLE STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1905
Mailing Address - Country:US
Mailing Address - Phone:603-622-7959
Mailing Address - Fax:603-626-1191
Practice Address - Street 1:65 MIDDLE STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1905
Practice Address - Country:US
Practice Address - Phone:603-622-7959
Practice Address - Fax:603-626-1191
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH618101YM0800X
MA5599101YM0800X
MECC2312101YM0800X
IL180-003812101YM0800X
NH1129103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30424223Medicaid