Healthcare Provider Details

I. General information

NPI: 1093961278
Provider Name (Legal Business Name): ZAANTI PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 PATCHEN RD
SOUTH BURLINGTON VT
05403-5704
US

IV. Provider business mailing address

34 PATCHEN RD
SOUTH BURLINGTON VT
05403-5704
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-4208
  • Fax: 802-658-2234
Mailing address:
  • Phone: 802-658-4208
  • Fax: 802-658-2234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number047-0000735
License Number StateVT

VIII. Authorized Official

Name: MS. CHRISTINE E RUSHFORTH
Title or Position: SOLE MEMBER OF LLC
Credential: M.A.
Phone: 802-658-4208