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General NPI Number Information
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NPI Number | 1053439950
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Entity Type | Individual
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Provider Name | JOHN T MORAN MA, LADC
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Gender | Male
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 51 FAIRVIEW ST
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City | BRATTLEBORO
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State | VT
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Zip | 05301-6629
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Country | US
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Telephone | 802-254-6028
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Fax | 802-254-7501
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Provider Business Mailing Address
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Address Line | 1 HOSPITAL CT STE 410
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City | BELLOWS FALLS
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State | VT
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Zip | 05101-1489
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Country | US
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Telephone | 802-463-3294
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Fax | 802-463-1206
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 000169
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 000169
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License Number State | VT
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