Provider Demographics
NPI:1346506243
Name:REMINGTON VAN HOESEN, KAITLIN R (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KAITLIN
Middle Name:R
Last Name:REMINGTON VAN HOESEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SCALE AVE
Mailing Address - Street 2:BLDG. 18 SUITE 117
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701
Mailing Address - Country:US
Mailing Address - Phone:802-773-2498
Mailing Address - Fax:802-773-2496
Practice Address - Street 1:1 SCALE AVE
Practice Address - Street 2:BLDG. 18 SUITE 117
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701
Practice Address - Country:US
Practice Address - Phone:802-773-2498
Practice Address - Fax:802-773-2496
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00803481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical