Healthcare Provider Details

I. General information

NPI: 1720009731
Provider Name (Legal Business Name): ELIZABETH COTTER EHRICH MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 TORY LN
ARLINGTON VT
05250-8978
US

IV. Provider business mailing address

21 TORY LN
ARLINGTON VT
05250-8978
US

V. Phone/Fax

Practice location:
  • Phone: 802-282-3302
  • Fax: 802-375-6110
Mailing address:
  • Phone: 802-282-3302
  • Fax: 802-375-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0890000615
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: