Basic Information
Provider Information | |||||||||
NPI: | 1689956807 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KUHLMAN | ||||||||
FirstName: | ALISABETH | ||||||||
MiddleName: | PEARL | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GROSS | ||||||||
OtherFirstName: | ALISABETH | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1138 PINE ST | ||||||||
Address2: |   | ||||||||
City: | BURLINGTON | ||||||||
State: | VT | ||||||||
PostalCode: | 054015353 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8024886600 | ||||||||
FaxNumber: | 8024886601 | ||||||||
Practice Location | |||||||||
Address1: | 31 HEATH ST | ||||||||
Address2: |   | ||||||||
City: | JAMAICA PLAIN | ||||||||
State: | MA | ||||||||
PostalCode: | 021301650 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6175236400 | ||||||||
FaxNumber: | 6178245836 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/14/2011 | ||||||||
LastUpdateDate: | 09/16/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 089-0103342 | VT | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.