Healthcare Provider Details

I. General information

NPI: 1477680189
Provider Name (Legal Business Name): ORANGE COUNTY PARENT CHILD CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 VT RTE 110
CHELSEA VT
05038-8994
US

IV. Provider business mailing address

361 VT RTE 110
CHELSEA VT
05038-8994
US

V. Phone/Fax

Practice location:
  • Phone: 802-685-2264
  • Fax: 802-685-2278
Mailing address:
  • Phone: 802-685-2264
  • Fax: 802-685-2278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MARYELLEN OTIS
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S.
Phone: 802-685-2264