Healthcare Provider Details

I. General information

NPI: 1902944846
Provider Name (Legal Business Name): CLARA MARTIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 S MAIN ST
RANDOLPH VT
05060-1330
US

IV. Provider business mailing address

11 S MAIN ST
RANDOLPH VT
05060-1330
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDA CHAMBERS
Title or Position: EXECUTIVE DIRECTOR
Credential: LADC
Phone: 802-728-4466