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NPI Code Detail

MEDICARE: KRISTEN CASELLA LCMHC

MEDICARE: KRISTEN CASELLA LCMHC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1396297594
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN CASELLA LCMHC
Provider Business Mailing Address
First Line : 78 S MAIN ST
Second Line :
City : RUTLAND
State : VT
Zip : 05701-4594
Country : US
Telephone Number : 802-775-8224
Fax Number : 802-747-7699
Provider Business Practice Location Address
First Line : 78 S MAIN ST
Second Line :
City : RUTLAND
State : VT
Zip : 05701-4594
Country : US
Telephone Number : 802-728-4466
Fax Number : 802-728-4197
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2016
Last Update Date : 08/22/2018

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Directions to “ KRISTEN CASELLA LCMHC” Practice Location

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