Provider Demographics
NPI:1184775694
Name:MAYNARD, KATHERINE HUDSPETH (MS)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:HUDSPETH
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 BRAND FARM DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7542
Mailing Address - Country:US
Mailing Address - Phone:802-862-2182
Mailing Address - Fax:802-654-7601
Practice Address - Street 1:20 W CANAL ST
Practice Address - Street 2:SUITE C2
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-2131
Practice Address - Country:US
Practice Address - Phone:802-654-7600
Practice Address - Fax:802-654-7601
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000158101YA0400X
VT068-0000481101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT208405OtherCIGNA BEHAVIORAL HEALTH C
VT1008141Medicaid
VT58349OtherBCBS OF VT
VT61225OtherMVP HEALTH CARE