Provider Demographics
NPI:1659700912
Name:KATHRYN FALLIN, M.S.
Entity Type:Organization
Organization Name:KATHRYN FALLIN, M.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST MASTER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:FALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:802-651-7514
Mailing Address - Street 1:11 CEDAR GLN N
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7334
Mailing Address - Country:US
Mailing Address - Phone:802-578-9728
Mailing Address - Fax:
Practice Address - Street 1:3 MAIN ST
Practice Address - Street 2:STE. 216
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5216
Practice Address - Country:US
Practice Address - Phone:802-651-7514
Practice Address - Fax:802-860-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047.0093667103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty