Healthcare Provider Details

I. General information

NPI: 1235120163
Provider Name (Legal Business Name): WILLIAM R. COTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PORTLAND ST
ST JOHNSBURY VT
05819-8635
US

IV. Provider business mailing address

416 CENTER ST. PO BOX 332
LYNDON CENTER VT
05850-0332
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-3181
  • Fax: 802-748-0704
Mailing address:
  • Phone: 802-626-8157
  • Fax: 802-626-4011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number1010012280
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number003
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: