Provider Demographics
NPI:1538103734
Name:MCKNIGHT, CAROL J (MA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 ROUTE 125
Mailing Address - Street 2:PO BOX 79
Mailing Address - City:RIPTON
Mailing Address - State:VT
Mailing Address - Zip Code:05766-0079
Mailing Address - Country:US
Mailing Address - Phone:802-388-6227
Mailing Address - Fax:802-388-4808
Practice Address - Street 1:1306 ROUTE 125
Practice Address - Street 2:
Practice Address - City:RIPTON
Practice Address - State:VT
Practice Address - Zip Code:05766-0079
Practice Address - Country:US
Practice Address - Phone:802-388-6227
Practice Address - Fax:802-388-4808
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000088101YM0800X
VT047-0000520103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005944228OtherAETNA
323458OtherMVP
00018214OtherBLUE CROSS/BLUE SHEILD
VT1003504Medicaid