Provider Demographics
NPI:1477028660
Name:DR. KATE VAILLANCOURT, PLLC
Entity Type:Organization
Organization Name:DR. KATE VAILLANCOURT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAILLANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:978-572-0703
Mailing Address - Street 1:2299 WOODBURY AVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7854
Mailing Address - Country:US
Mailing Address - Phone:978-572-0703
Mailing Address - Fax:
Practice Address - Street 1:2299 WOODBURY AVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-7854
Practice Address - Country:US
Practice Address - Phone:978-572-0703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty