Provider Demographics
NPI:1285386243
Name:COMENZO, KARINNE (MA, LICSW, LADC)
Entity type:Individual
Prefix:
First Name:KARINNE
Middle Name:
Last Name:COMENZO
Suffix:
Gender:F
Credentials:MA, LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 TUCKAWAY POND LN
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-1122
Mailing Address - Country:US
Mailing Address - Phone:917-676-7526
Mailing Address - Fax:
Practice Address - Street 1:280 STATE DRIVE NOB 2 SOUTH
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05671-0001
Practice Address - Country:US
Practice Address - Phone:802-585-9330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151.0127940101YA0400X
VT089.01242381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)