Healthcare Provider Details

I. General information

NPI: 1245004779
Provider Name (Legal Business Name): MARTHA ERIN PHELPS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 ALLEN BROOK LN
WILLISTON VT
05495-9207
US

IV. Provider business mailing address

147 ALLEN BROOK LN
WILLISTON VT
05495-9207
US

V. Phone/Fax

Practice location:
  • Phone: 802-876-7111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number146.0134487
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: