Provider Demographics
NPI:1225058522
Name:KROTINGER, NICOLE R (MS, LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:R
Last Name:KROTINGER
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 LINCOLN GAP RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:VT
Mailing Address - Zip Code:05674-9479
Mailing Address - Country:US
Mailing Address - Phone:802-496-5332
Mailing Address - Fax:802-496-5332
Practice Address - Street 1:65 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1550
Practice Address - Country:US
Practice Address - Phone:802-496-5332
Practice Address - Fax:802-496-5332
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
068-0000675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00069081OtherBC/BS OF VT
VT1012235Medicaid
VT372833OtherTRICARE
VT2132455OtherCIGNA