Provider Demographics
NPI:1467061879
Name:KIRK, KATRINE (PSYCHOLOGIST-MASTER)
Entity Type:Individual
Prefix:
First Name:KATRINE
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:PSYCHOLOGIST-MASTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:VT
Mailing Address - Zip Code:05674-0356
Mailing Address - Country:US
Mailing Address - Phone:802-917-1980
Mailing Address - Fax:
Practice Address - Street 1:334 ROXBURY MOUNTAIN ROAD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:VT
Practice Address - Zip Code:05674
Practice Address - Country:US
Practice Address - Phone:802-917-1980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047.0123605103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist