Healthcare Provider Details

I. General information

NPI: 1790446599
Provider Name (Legal Business Name): DONALD CUERDON MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 PARK PL
BRATTLEBORO VT
05301-2827
US

IV. Provider business mailing address

279 WESTMINSTER RD
PUTNEY VT
05346-8126
US

V. Phone/Fax

Practice location:
  • Phone: 802-258-7116
  • Fax:
Mailing address:
  • Phone: 802-258-7116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number097.0134736
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: