Provider Demographics
NPI:1538588611
Name:BAUDREAU, KATHRYN ALICE (LICSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ALICE
Last Name:BAUDREAU
Suffix:
Gender:X
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 DORSET ST SUITE 245
Mailing Address - Street 2:PMB 247
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403
Mailing Address - Country:US
Mailing Address - Phone:802-316-8717
Mailing Address - Fax:
Practice Address - Street 1:373 BLAIR PARK RD UNIT 206
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-8056
Practice Address - Country:US
Practice Address - Phone:802-316-8717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00932171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical