Provider Demographics
NPI:1710863121
Name:MORRISSEY, KAITLYN MICHELLE
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MICHELLE
Last Name:MORRISSEY
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:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMORE
Mailing Address - State:VT
Mailing Address - Zip Code:05657-0155
Mailing Address - Country:US
Mailing Address - Phone:802-363-5715
Mailing Address - Fax:
Practice Address - Street 1:72 HARREL ST
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8526
Practice Address - Country:US
Practice Address - Phone:802-363-5715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0136739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health