Provider Demographics
NPI:1114083698
Name:LOCOCO, KRISTEN R (LCMHC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:R
Last Name:LOCOCO
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 FAIRFIELD HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-9634
Mailing Address - Country:US
Mailing Address - Phone:802-524-1700
Mailing Address - Fax:802-524-1777
Practice Address - Street 1:12 FAIRFIELD HILL ROAD
Practice Address - Street 2:
Practice Address - City:ST. ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478
Practice Address - Country:US
Practice Address - Phone:802-524-1700
Practice Address - Fax:802-524-1777
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000244101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT28703OtherBCBS
VT991062OtherMVP
VT115274OtherTEAMSTERS
VT151960000OtherMEGELLAN
VT246067421OtherUBH
VT1007560Medicaid
VT21219205781OtherBEECH STREET
VT094408OtherOPTIONS
VT1060059OtherCIGNA