Provider Demographics
NPI:1467117952
Name:BURDICK, KIRSTEN TAYLOR (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:TAYLOR
Last Name:BURDICK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:KIRSTEN
Other - Middle Name:TAYLOR
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT-A
Mailing Address - Street 1:456 PARUM RD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1931
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:233 MAIN ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-4206
Practice Address - Country:US
Practice Address - Phone:860-229-4830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2753106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist