Healthcare Provider Details

I. General information

NPI: 1528779170
Provider Name (Legal Business Name): SIMONE ARNOLD VT 068.0135424
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SIMONE ARNOLD

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 EAGLE LEDGE RD
WORCESTER VT
05682-9617
US

IV. Provider business mailing address

83 EAGLE LEDGE RD
WORCESTER VT
05682-9617
US

V. Phone/Fax

Practice location:
  • Phone: 802-431-7155
  • Fax: 802-318-4187
Mailing address:
  • Phone: 802-431-7155
  • Fax: 802-318-4187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number097.0134717
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: