Provider Demographics
NPI:1568717387
Name:BURNS, KATHLEEN GRACE (MS ED/)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:GRACE
Last Name:BURNS
Suffix:
Gender:F
Credentials:MS ED/
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 4546
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941
Mailing Address - Country:US
Mailing Address - Phone:845-800-1611
Mailing Address - Fax:570-409-9737
Practice Address - Street 1:117 HOBBLEBUSH CT
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-7149
Practice Address - Country:US
Practice Address - Phone:845-800-1611
Practice Address - Fax:570-409-9737
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist