Provider Demographics
NPI:1538353909
Name:BERTHIAUME, KRISTEN SUZANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:SUZANNE
Last Name:BERTHIAUME
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:SUZANNE
Other - Last Name:WHIRLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 59076
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35259-9076
Mailing Address - Country:US
Mailing Address - Phone:205-352-9702
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 59076
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35259-9076
Practice Address - Country:US
Practice Address - Phone:205-352-9702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1464103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical