Healthcare Provider Details

I. General information

NPI: 1700756624
Provider Name (Legal Business Name): MAYA JAMALEDDINE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 COLLEGE ST STE 303
BURLINGTON VT
05401-8476
US

IV. Provider business mailing address

64 LITTLE EAGLE BAY
BURLINGTON VT
05408-2781
US

V. Phone/Fax

Practice location:
  • Phone: 918-695-5061
  • Fax:
Mailing address:
  • Phone: 918-695-5061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0137428
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: