Provider Demographics
NPI:1699954487
Name:BENNETT, KARY ANN (MA)
Entity type:Individual
Prefix:
First Name:KARY
Middle Name:ANN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 849
Mailing Address - Street 2:
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672-0849
Mailing Address - Country:US
Mailing Address - Phone:802-343-4796
Mailing Address - Fax:802-888-2244
Practice Address - Street 1:56 OLD FARM RD
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672-4248
Practice Address - Country:US
Practice Address - Phone:802-343-4796
Practice Address - Fax:802-888-2244
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000751101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1015274Medicaid