Provider Demographics
NPI:1801109426
Name:VAUGHTON, KATHLEEN (LMHC LADC1)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:VAUGHTON
Suffix:
Gender:F
Credentials:LMHC LADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 TROUT FARM LN
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-4609
Mailing Address - Country:US
Mailing Address - Phone:781-936-8660
Mailing Address - Fax:
Practice Address - Street 1:113 TREMONT ST
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-4753
Practice Address - Country:US
Practice Address - Phone:781-934-6226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-24
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC 4070101Y00000X
MALADC1 1017101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor