Healthcare Provider Details

I. General information

NPI: 1689509614
Provider Name (Legal Business Name): DAMIR ALISA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 VEST HAVEN DR
BURLINGTON VT
05408-1835
US

IV. Provider business mailing address

60 VEST HAVEN DR
BURLINGTON VT
05408-1835
US

V. Phone/Fax

Practice location:
  • Phone: 802-399-9597
  • Fax:
Mailing address:
  • Phone: 802-399-9597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0137237
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: