Provider Demographics
NPI:1427598200
Name:KATHRYN RICKARD PSYD PLLC
Entity Type:Organization
Organization Name:KATHRYN RICKARD PSYD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:802-498-7305
Mailing Address - Street 1:250 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-4257
Mailing Address - Country:US
Mailing Address - Phone:802-498-7305
Mailing Address - Fax:
Practice Address - Street 1:250 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-4257
Practice Address - Country:US
Practice Address - Phone:802-498-7305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0480059488103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1018279Medicaid
VT001947401Medicare PIN