Provider Demographics
NPI:1619433364
Name:CORNFORTH, KRISTI (LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:CORNFORTH
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:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-0189
Mailing Address - Country:US
Mailing Address - Phone:802-227-2670
Mailing Address - Fax:
Practice Address - Street 1:56 W TWIN OAKS TER STE 3
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7138
Practice Address - Country:US
Practice Address - Phone:802-227-2670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01228741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT089.0122874OtherVERMONT STATE LICENSE