Provider Demographics
NPI:1578664058
Name:BURGIO, KATHRYN L (PHD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:BURGIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 LAKEWOOD TRCE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4441
Mailing Address - Country:US
Mailing Address - Phone:205-980-0473
Mailing Address - Fax:
Practice Address - Street 1:700 19TH ST S
Practice Address - Street 2:BIRMINGHAM VA MEDICAL CENTER / 11G
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1927
Practice Address - Country:US
Practice Address - Phone:205-933-8101
Practice Address - Fax:205-558-7068
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL738103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral