Provider Demographics
NPI:1952324535
Name:BURLINGAME, KATHLEEN SUSAN (MFT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:SUSAN
Last Name:BURLINGAME
Suffix:
Gender:F
Credentials:MFT
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 162972
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-2972
Mailing Address - Country:US
Mailing Address - Phone:916-214-9800
Mailing Address - Fax:
Practice Address - Street 1:3331 POWER INN RD
Practice Address - Street 2:SUITE 170
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3889
Practice Address - Country:US
Practice Address - Phone:916-875-9980
Practice Address - Fax:916-875-7770
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31089106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist