=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285716134
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN BAE KNIGHT LICSW, LADC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23 SCHOOL STREET
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05143-0332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-875-1594
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 332 23 SCHOOL STREET
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05143-0332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-875-1594
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 089-0000842
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------