Healthcare Provider Details

I. General information

NPI: 1629522990
Provider Name (Legal Business Name): ALICIA E GELFANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N MAIN ST
RANDOLPH VT
05060-1126
US

IV. Provider business mailing address

594 ROGERS HILL RD
BRADFORD VT
05033-9096
US

V. Phone/Fax

Practice location:
  • Phone: 802-728-4466
  • Fax: 802-728-4197
Mailing address:
  • Phone: 802-334-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000715
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: