Healthcare Provider Details

I. General information

NPI: 1013050293
Provider Name (Legal Business Name): CYNTHIA GOGAN LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LEDGEHILL RD
BENNINGTON VT
05201-2273
US

IV. Provider business mailing address

100 LEDGE HILL DR
BENNINGTON VT
05201-0588
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-5491
  • Fax: 802-442-3363
Mailing address:
  • Phone: 802-362-3950
  • Fax: 802-362-0325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068-0115765
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: