Provider Demographics
NPI:1619668241
Name:BARD, KATE (ATR-BC, LCAT, SAC)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:BARD
Suffix:
Gender:F
Credentials:ATR-BC, LCAT, SAC
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 PAXTON ST
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01524-1117
Mailing Address - Country:US
Mailing Address - Phone:718-637-1751
Mailing Address - Fax:
Practice Address - Street 1:220 PAXTON ST
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:MA
Practice Address - Zip Code:01524-1117
Practice Address - Country:US
Practice Address - Phone:718-637-1751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA507636101YS0200X
NY001324221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool