Provider Demographics
NPI:1609848324
Name:LONGMAID, KATE JESSAMYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATE
Middle Name:JESSAMYN
Last Name:LONGMAID
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 1:110 MAIN ST
Mailing Address - Street 2:4TH FLOOR, SUITE 4B
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8451
Mailing Address - Country:US
Mailing Address - Phone:802-651-7535
Mailing Address - Fax:
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:4TH FLOOR, SUITE 4B
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8451
Practice Address - Country:US
Practice Address - Phone:802-651-7535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000630103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVN1205OtherMEDICARE PTAN
VTOVN1205Medicaid
VTVN1205OtherMEDICARE PTAN