Healthcare Provider Details

I. General information

NPI: 1659299196
Provider Name (Legal Business Name): CUONG TRAN MA, PLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LOREN TRAN MA, PLC

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 MIDDLE RD
COLCHESTER VT
05446-7303
US

IV. Provider business mailing address

107 MIDDLE RD
COLCHESTER VT
05446-7303
US

V. Phone/Fax

Practice location:
  • Phone: 802-488-9227
  • Fax:
Mailing address:
  • Phone: 802-488-9227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number097.0136880
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: