Provider Demographics
NPI:1285716134
Name:KNIGHT, KAREN BAE (LICSW, LADC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:BAE
Last Name:KNIGHT
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 332
Mailing Address - Street 2:23 SCHOOL STREET
Mailing Address - City:CHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05143-0332
Mailing Address - Country:US
Mailing Address - Phone:802-875-1594
Mailing Address - Fax:
Practice Address - Street 1:23 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VT
Practice Address - Zip Code:05143-0332
Practice Address - Country:US
Practice Address - Phone:802-875-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00008421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT58330OtherBLUE CROSS BLUE SHIELD
VT1008031Medicaid
VT1008031Medicaid