Provider Demographics
NPI:1952326456
Name:KOKAREV, DAY (MSW)
Entity Type:Individual
Prefix:MR
First Name:DAY
Middle Name:
Last Name:KOKAREV
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 CROSSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-9029
Mailing Address - Country:US
Mailing Address - Phone:802-229-4150
Mailing Address - Fax:802-229-5226
Practice Address - Street 1:1954 CROSSTOWN RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9029
Practice Address - Country:US
Practice Address - Phone:802-229-4150
Practice Address - Fax:802-229-5226
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT89-811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006708Medicaid
VT1006708Medicaid