Healthcare Provider Details

I. General information

NPI: 1720528227
Provider Name (Legal Business Name): NORTHEAST KINGDOM HUMAN SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 CRAWFORD ROAD
DERBY VT
05829-9999
US

IV. Provider business mailing address

PO BOX 724
NEWPORT VT
05855-0724
US

V. Phone/Fax

Practice location:
  • Phone: 802-334-6744
  • Fax: 802-334-7340
Mailing address:
  • Phone: 802-334-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: KATHY MONTY
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 802-334-7451