Healthcare Provider Details

I. General information

NPI: 1164826038
Provider Name (Legal Business Name): EASTER SEALS VERMONT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 N MAIN ST STE 3004
BARRE VT
05641-4197
US

IV. Provider business mailing address

555 AUBURN STREET
MANCHESTER NH
03103
US

V. Phone/Fax

Practice location:
  • Phone: 802-622-3230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CLAIRE GAGNON
Title or Position: CFO
Credential:
Phone: 603-621-3516