Provider Demographics
NPI:1780920728
Name:BARRETT, KATHLEEN (PSYD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 HERITAGE VILLAGE PLZ STE 230
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3095
Mailing Address - Country:US
Mailing Address - Phone:571-488-9840
Mailing Address - Fax:571-488-9841
Practice Address - Street 1:7001 HERITAGE VILLAGE PLZ STE 230
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3095
Practice Address - Country:US
Practice Address - Phone:571-488-9840
Practice Address - Fax:571-488-9841
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004667103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical