Healthcare Provider Details

I. General information

NPI: 1659406296
Provider Name (Legal Business Name): VERMONT DEPARTMENT OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 CHERRY ST
BURLINGTON VT
05401-4295
US

IV. Provider business mailing address

PO BOX 70 108 CHERRY ST.
BURLINGTON VT
05402-0070
US

V. Phone/Fax

Practice location:
  • Phone: 802-652-2045
  • Fax: 802-865-7754
Mailing address:
  • Phone: 802-652-2045
  • Fax: 802-865-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WON CHO
Title or Position: ACCOUNTANT
Credential:
Phone: 802-652-2045