1114083698 NPI number — KRISTEN R LOCOCO LCMHC

Table of content: KRISTEN R LOCOCO LCMHC (NPI 1114083698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114083698 NPI number — KRISTEN R LOCOCO LCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOCOCO
Provider First Name:
KRISTEN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCMHC
Provider Gender Code:
F

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:
1114083698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 FAIRFIELD HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT ALBANS
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05478-9634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-524-1700
Provider Business Mailing Address Fax Number:
802-524-1777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 FAIRFIELD HILL ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-524-1700
Provider Business Practice Location Address Fax Number:
802-524-1777
Provider Enumeration Date:
12/28/2006

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: 101YM0800X , with the licence number:  068-0000244 , 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: 28703 . This is a "BCBS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 991062 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 115274 . This is a "TEAMSTERS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 151960000 . This is a "MEGELLAN" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 246067421 . This is a "UBH" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1007560 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21219205781 . This is a "BEECH STREET" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 094408 . This is a "OPTIONS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1060059 . This is a "CIGNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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