Provider Demographics
NPI:1912236787
Name:PETERS, KATHRYN E (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:PETERS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:GUILDHALL
Mailing Address - State:VT
Mailing Address - Zip Code:05905-0102
Mailing Address - Country:US
Mailing Address - Phone:802-328-1955
Mailing Address - Fax:
Practice Address - Street 1:2494 ROUTE 102
Practice Address - Street 2:
Practice Address - City:GUILDHALL
Practice Address - State:VT
Practice Address - Zip Code:05905
Practice Address - Country:US
Practice Address - Phone:570-780-8095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01344511041C0700X
MELC136091041C0700X
NH16421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical