Provider Demographics
NPI:1922648369
Name:KRETVIX, HANNAH (LADC)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:KRETVIX
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 E ALLEN ST APT B
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1560
Mailing Address - Country:US
Mailing Address - Phone:802-345-7785
Mailing Address - Fax:802-488-6919
Practice Address - Street 1:383 E ALLEN ST APT B
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1560
Practice Address - Country:US
Practice Address - Phone:802-345-7785
Practice Address - Fax:802-488-6919
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151-0134088101YA0400X
VT089.1344721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6702805Medicaid