Provider Demographics
NPI:1154904225
Name:BURLINGAME, KATHERINE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BURLINGAME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31A WORKSHOP RD
Mailing Address - Street 2:
Mailing Address - City:S YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-1210
Mailing Address - Country:US
Mailing Address - Phone:508-398-5155
Mailing Address - Fax:508-398-5393
Practice Address - Street 1:31A WORKSHOP RD
Practice Address - Street 2:
Practice Address - City:S YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-1210
Practice Address - Country:US
Practice Address - Phone:508-398-5155
Practice Address - Fax:508-398-5393
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN141384163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)