Healthcare Provider Details

I. General information

NPI: 1114008828
Provider Name (Legal Business Name): JANE HANLEY LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 COURT SQ
RUTLAND VT
05701-4030
US

IV. Provider business mailing address

183 BEARLY HI WAY
KILLINGTON VT
05701
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-4388
  • Fax: 802-775-3307
Mailing address:
  • Phone: 802-422-3271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0680000203
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: