Provider Demographics
NPI:1366803819
Name:BURLEY, KATHLEEN (MED)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BURLEY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3R SMITH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01966-1327
Mailing Address - Country:US
Mailing Address - Phone:978-564-5137
Mailing Address - Fax:
Practice Address - Street 1:42 MASON ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2257
Practice Address - Country:US
Practice Address - Phone:978-744-1585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health