Healthcare Provider Details

I. General information

NPI: 1942920442
Provider Name (Legal Business Name): STOWE THERAPEUTIC SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 MOUNTAIN RD
STOWE VT
05672-4804
US

IV. Provider business mailing address

40 TAMARACK LN
WATERBURY CENTER VT
05677-4415
US

V. Phone/Fax

Practice location:
  • Phone: 561-891-9643
  • Fax:
Mailing address:
  • Phone: 561-891-9643
  • Fax:

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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SEAN RYAN
Title or Position: PRINICPAL
Credential: LICSW, LADC
Phone: 561-891-9643