Provider Demographics
NPI:1548887763
Name:BORDEN, KATHI
Entity type:Individual
Prefix:
First Name:KATHI
Middle Name:
Last Name:BORDEN
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 1:215 VALLEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:SPOFFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03462-4635
Mailing Address - Country:US
Mailing Address - Phone:603-313-3020
Mailing Address - Fax:
Practice Address - Street 1:40 AVON ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3516
Practice Address - Country:US
Practice Address - Phone:603-352-1024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH946103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical