Provider Demographics
NPI:1831290196
Name:MORRISSEY, KATHLEEN P (LCMHC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:P
Last Name:MORRISSEY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:P
Other - Last Name:MORRISSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCMHC
Mailing Address - Street 1:20 W CANAL ST STE C10
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-2147
Mailing Address - Country:US
Mailing Address - Phone:802-651-7547
Mailing Address - Fax:
Practice Address - Street 1:1775 WILLISTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6429
Practice Address - Country:US
Practice Address - Phone:802-847-6184
Practice Address - Fax:802-847-6140
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000590101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009091Medicaid