Provider Demographics
NPI:1063586873
Name:HUGHES, M. KATRINE (LICSW/LCSW)
Entity type:Individual
Prefix:
First Name:M.
Middle Name:KATRINE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:LICSW/LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATRINE
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW/LICSW
Mailing Address - Street 1:1 JACKSON HTS
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4552
Mailing Address - Country:US
Mailing Address - Phone:802-770-8777
Mailing Address - Fax:877-501-7757
Practice Address - Street 1:92 CENTER ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4019
Practice Address - Country:US
Practice Address - Phone:802-770-8777
Practice Address - Fax:877-501-7757
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS139721041C0700X
VT089.00592101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0021366OtherMEDICARE PTAN
VT1019159Medicaid
CACSW139721Medicaid