Provider Demographics
NPI:1518293869
Name:MCCRACKEN, KELLY (MSW, MPH)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:MSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1323
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-1323
Mailing Address - Country:US
Mailing Address - Phone:802-522-6377
Mailing Address - Fax:
Practice Address - Street 1:295 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4108
Practice Address - Country:US
Practice Address - Phone:802-522-6377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900466631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical