Healthcare Provider Details

I. General information

NPI: 1497468292
Provider Name (Legal Business Name): VERMONT DEPARTMENT OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 WOODSIDE DR E
COLCHESTER VT
05446-3128
US

IV. Provider business mailing address

280 STATE DR NOB 2 NORTH
WATERBURY VT
05671-2010
US

V. Phone/Fax

Practice location:
  • Phone: 802-241-0090
  • Fax:
Mailing address:
  • Phone: 802-241-0118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SHANNON THOMPSON
Title or Position: FINANCIAL DIRECTOR IV
Credential:
Phone: 802-241-0118