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General NPI Number Information
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NPI Number | 1053048793
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Entity Type | Organization
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Legal Business Name | GREEN MOUNTAIN AID, INC.
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 86 SAINT PAUL ST STE 311
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City | BURLINGTON
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State | VT
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Zip | 05401-4958
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Country | US
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Telephone | 802-753-7934
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Fax |
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Provider Business Mailing Address
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Address Line | 86 SAINT PAUL ST STE 311
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City | BURLINGTON
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State | VT
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Zip | 05401-4958
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Country | US
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Telephone | 802-753-7934
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | KRISTA REINCKE
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Credential | PSYD
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Telephone | 802-735-7934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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