Healthcare Provider Details

I. General information

NPI: 1760501936
Provider Name (Legal Business Name): BENNINGTON SCHOOL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 FAIRVIEW ST
BENNINGTON VT
05201-9239
US

IV. Provider business mailing address

192 FAIRVIEW ST
BENNINGTON VT
05201-9239
US

V. Phone/Fax

Practice location:
  • Phone: 802-447-1557
  • Fax: 802-447-3234
Mailing address:
  • Phone: 802-447-1557
  • Fax: 802-447-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY P LABONTE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 802-447-1557