Healthcare Provider Details

I. General information

NPI: 1972466092
Provider Name (Legal Business Name): MARK STEVEN GINSBURG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CLIFFORD DR # 102
MILTON VT
05468-4395
US

IV. Provider business mailing address

14 CLIFFORD DR # 102
MILTON VT
05468-4395
US

V. Phone/Fax

Practice location:
  • Phone: 802-881-3847
  • Fax:
Mailing address:
  • Phone: 802-881-3847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number097.0136463
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: