Provider Demographics
NPI:1598418345
Name:KUTZNER, MALLORIE MAE (MS, LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:MALLORIE
Middle Name:MAE
Last Name:KUTZNER
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 FAIRFIELD ST # 9
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1796
Mailing Address - Country:US
Mailing Address - Phone:802-310-0342
Mailing Address - Fax:
Practice Address - Street 1:67 FAIRFIELD ST # 9
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1796
Practice Address - Country:US
Practice Address - Phone:802-310-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health