Provider Demographics
NPI:1851463574
Name:KATZ, JARED DANIEL (LCMHC)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:DANIEL
Last Name:KATZ
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W CANAL ST STE C8
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-2147
Mailing Address - Country:US
Mailing Address - Phone:802-343-4102
Mailing Address - Fax:802-497-2191
Practice Address - Street 1:20 W CANAL ST STE C8
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-2147
Practice Address - Country:US
Practice Address - Phone:802-343-4102
Practice Address - Fax:802-497-2191
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011401Medicaid