Provider Demographics
NPI:1922552207
Name:ZURA, KAITLIN IRENE (MA)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:IRENE
Last Name:ZURA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6432
Mailing Address - Country:US
Mailing Address - Phone:802-951-0450
Mailing Address - Fax:
Practice Address - Street 1:3000 WILLISTON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6082
Practice Address - Country:US
Practice Address - Phone:802-951-0450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0120413103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047.0133680OtherSTATE OF VERMONT