MEDICARE: JODY LYNN KAMON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	048.0000904	VT
2	101YM0800X	Mental Health Counselor	048.0000904	VT
3	103TA0400X	Addiction (Substance Use Disorder) Psychologist	048.0000904	VT
4	103TC0700X	Clinical Psychologist	048.0000904	VT

General Provider Information

NPI Number	:	1144597568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY LYNN KAMON PHD

Provider Business Mailing Address
First Line	:	16 ROSEWOOD TRL
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-3332
Country	:	US
Telephone Number	:	802-999-1676
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 ROSEWOOD TRL
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-3332
Country	:	US
Telephone Number	:	802-999-1676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	07/25/2025

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