Healthcare Provider Details

I. General information

NPI: 1558511428
Provider Name (Legal Business Name): NANCY J PIKE LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 RIVER ST C/O NETWORK MANAGEMENT SERVICES
SPRINGFIELD VT
05156-2306
US

IV. Provider business mailing address

1 HOSPITAL CT SPRINGFIELD HOSPITAL PSYCHIATRY
BELLOWS FALLS VT
05101-1489
US

V. Phone/Fax

Practice location:
  • Phone: 802-885-5785
  • Fax: 802-885-2030
Mailing address:
  • Phone: 802-463-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068-0000134
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: