Provider Demographics
NPI:1144597568
Name:KAMON, JODY LYNN (PSYCHOLOGIST-DOCTORA)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:LYNN
Last Name:KAMON
Suffix:
Gender:F
Credentials:PSYCHOLOGIST-DOCTORA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4347
Mailing Address - Country:US
Mailing Address - Phone:802-864-7423
Mailing Address - Fax:802-660-0576
Practice Address - Street 1:31 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4347
Practice Address - Country:US
Practice Address - Phone:802-864-7423
Practice Address - Fax:802-660-0576
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0000904101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health