Provider Demographics
NPI:1013263607
Name:BURDICK, KATHERINE (LMFT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BURDICK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 HILLIARD ST STE 1302
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-2705
Mailing Address - Country:US
Mailing Address - Phone:860-748-5441
Mailing Address - Fax:860-812-2442
Practice Address - Street 1:642 HILLIARD ST STE 1302
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-2705
Practice Address - Country:US
Practice Address - Phone:860-748-5441
Practice Address - Fax:860-812-2442
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1537106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008041648Medicaid