Healthcare Provider Details

I. General information

NPI: 1881560787
Provider Name (Legal Business Name): TIMOTHY HALTEMAN LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

1 S PROSPECT ST
BURLINGTON VT
05401-3456
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-7373
  • Fax: 802-847-7628
Mailing address:
  • Phone: 802-847-7373
  • Fax: 802-847-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number089.0136552
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0136522
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: