Provider Demographics
NPI:1528133063
Name:PROPP, KRISTIN WILLIAMS (MA)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:WILLIAMS
Last Name:PROPP
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BENMONT AVE
Mailing Address - Street 2:SUITE 18
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-1873
Mailing Address - Country:US
Mailing Address - Phone:802-442-2722
Mailing Address - Fax:802-753-7167
Practice Address - Street 1:160 BENMONT AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1873
Practice Address - Country:US
Practice Address - Phone:802-442-2722
Practice Address - Fax:802-753-7167
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000556103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1004399Medicaid