Provider Demographics
NPI:1902161698
Name:RICK, KATHRYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:RICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LAMOILLE ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3729
Mailing Address - Country:US
Mailing Address - Phone:802-871-5635
Mailing Address - Fax:
Practice Address - Street 1:28 PARK AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-9701
Practice Address - Country:US
Practice Address - Phone:802-878-0550
Practice Address - Fax:802-878-0440
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0000631103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist