Provider Demographics
NPI:1568118933
Name:RICHARDSON, KAYLA (LMSW)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 MAIN ST # 39
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-2932
Mailing Address - Country:US
Mailing Address - Phone:802-225-8355
Mailing Address - Fax:
Practice Address - Street 1:73 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2932
Practice Address - Country:US
Practice Address - Phone:802-225-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT156.0133925104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker