Provider Demographics
NPI:1386420222
Name:KATHRYN BURNETT, PSYD LLC
Entity type:Organization
Organization Name:KATHRYN BURNETT, PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR & CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:240-855-6585
Mailing Address - Street 1:15630 OLD COLUMBIA PIKE
Mailing Address - Street 2:SUITE E # 323
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866
Mailing Address - Country:US
Mailing Address - Phone:240-855-6585
Mailing Address - Fax:
Practice Address - Street 1:15630 OLD COLUMBIA PIKE
Practice Address - Street 2:SUITE E # 323
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866
Practice Address - Country:US
Practice Address - Phone:240-855-6585
Practice Address - Fax:240-836-2756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty