Healthcare Provider Details

I. General information

NPI: 1972809101
Provider Name (Legal Business Name): ANN E LAROCQUE LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2011
Last Update Date: 02/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 PLEASANT ST
WOODSTOCK VT
05091-1122
US

IV. Provider business mailing address

PO BOX 224
BRIDGEWATER VT
05034-0224
US

V. Phone/Fax

Practice location:
  • Phone: 802-672-1891
  • Fax:
Mailing address:
  • Phone: 802-672-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0680000731
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: