Provider Demographics
NPI:1427117191
Name:KAMENETZKY, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KAMENETZKY
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 1:167 MAIN ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-7128
Mailing Address - Country:US
Mailing Address - Phone:802-254-6038
Mailing Address - Fax:
Practice Address - Street 1:167 MAIN ST
Practice Address - Street 2:SUITE 16
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7128
Practice Address - Country:US
Practice Address - Phone:802-254-6038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT470000461103T00000X
VT47-0000461103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1002958Medicaid
VT6554OtherBLUE CROSS BLUE SHIELD