Healthcare Provider Details

I. General information

NPI: 1245192855
Provider Name (Legal Business Name): CHARLOTTE LEITZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 MORRISVILLE PLZ
MORRISVILLE VT
05661-4482
US

IV. Provider business mailing address

66 MORRISVILLE PLZ
MORRISVILLE VT
05661-4482
US

V. Phone/Fax

Practice location:
  • Phone: 802-888-8320
  • Fax: 802-888-8136
Mailing address:
  • Phone: 802-888-8320
  • Fax: 802-888-8136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: