1568437051 NPI number — MR. KENNETH L HUNT LICSW

Table of content: MR. KENNETH L HUNT LICSW (NPI 1568437051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568437051 NPI number — MR. KENNETH L HUNT LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUNT
Provider First Name:
KENNETH
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568437051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
92 CONGRESS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST ALBANS
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05478-1646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-524-0979
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 FISHER POND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST ALBANS
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05478-6286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-524-6555
Provider Business Practice Location Address Fax Number:
802-524-6562
Provider Enumeration Date:
02/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  089-0000255 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 356393 . This is a "MHN" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 2031778 . This is a "CIGNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: P00239533 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1007227 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 233980 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 28968 . This is a "BCBS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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