Provider Demographics
NPI:1811079494
Name:KAYE, KATHRYN (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:KAYE
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 1:90 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5418
Mailing Address - Country:US
Mailing Address - Phone:303-715-9900
Mailing Address - Fax:303-459-0106
Practice Address - Street 1:2501 WALNUT ST STE 201
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5753
Practice Address - Country:US
Practice Address - Phone:303-715-9900
Practice Address - Fax:303-459-0106
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1258103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99216Medicare ID - Type UnspecifiedPROVIDER #