Provider Demographics
NPI:1093892176
Name:CANFIELD, KATHERINE E (LADC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3024
Mailing Address - Country:US
Mailing Address - Phone:866-639-9753
Mailing Address - Fax:866-639-9753
Practice Address - Street 1:162 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3024
Practice Address - Country:US
Practice Address - Phone:866-639-9573
Practice Address - Fax:866-639-9573
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000036101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00018485OtherBC/BS