Healthcare Provider Details

I. General information

NPI: 1568325215
Provider Name (Legal Business Name): ZACHARY KUDMAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 KILBURN ST STE 305
BURLINGTON VT
05401-4783
US

IV. Provider business mailing address

211 MAIN ST UNIT 307
WINOOSKI VT
05404-1432
US

V. Phone/Fax

Practice location:
  • Phone: 802-448-2326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: