Provider Demographics
NPI:1851423115
Name:KRAHAM, KAREN WITSON (LICSW, LADC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:WITSON
Last Name:KRAHAM
Suffix:
Gender:F
Credentials:LICSW, LADC
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 501
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-0501
Mailing Address - Country:US
Mailing Address - Phone:802-257-6930
Mailing Address - Fax:802-257-0051
Practice Address - Street 1:38 PARK PL
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-2827
Practice Address - Country:US
Practice Address - Phone:802-257-6930
Practice Address - Fax:802-257-0051
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-0000830101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008023Medicaid
VT0005050Medicaid