Healthcare Provider Details

I. General information

NPI: 1033721683
Provider Name (Legal Business Name): ALAN JASON GELFANT LADC, LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BUCK RD STE J2
HANOVER NH
03755-2715
US

IV. Provider business mailing address

2 BUCK RD STE J
HANOVER NH
03755-2715
US

V. Phone/Fax

Practice location:
  • Phone: 603-865-1321
  • Fax: 603-865-1327
Mailing address:
  • Phone: 603-865-1321
  • Fax: 603-865-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number151.0134096EMGY
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: