Healthcare Provider Details

I. General information

NPI: 1053048793
Provider Name (Legal Business Name): GREEN MOUNTAIN AID, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 SAINT PAUL ST STE 311
BURLINGTON VT
05401-4958
US

IV. Provider business mailing address

86 SAINT PAUL ST STE 311
BURLINGTON VT
05401-4958
US

V. Phone/Fax

Practice location:
  • Phone: 802-753-7934
  • Fax:
Mailing address:
  • Phone: 802-753-7934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KRISTA REINCKE
Title or Position: CLINICAL DIRECTOR
Credential: PSYD
Phone: 802-735-7934