Provider Demographics
NPI:1497146377
Name:KITTREDGE, AMY (MS, LCMHC, LADC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:KITTREDGE
Suffix:
Gender:F
Credentials:MS, LCMHC, LADC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:YANDOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:71 ALLEN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4570
Mailing Address - Country:US
Mailing Address - Phone:800-468-9118
Mailing Address - Fax:802-772-7973
Practice Address - Street 1:420 GROVE ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:VT
Practice Address - Zip Code:05733-9062
Practice Address - Country:US
Practice Address - Phone:802-247-6304
Practice Address - Fax:802-247-6040
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000626101YA0400X
VT068.0099058101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1024498Medicaid