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General NPI Number Information
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NPI Number | 1386710861
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Entity Type | Organization
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Legal Business Name | CLARA MARTIN CENTER
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 11 S MAIN ST
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City | RANDOLPH
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State | VT
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Zip | 05060-1330
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Country | US
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Telephone | 802-728-4466
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Fax | 802-728-4197
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Provider Business Mailing Address
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Address Line | PO BOX G
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City | RANDOLPH
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State | VT
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Zip | 05060-0167
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Country | US
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Telephone | 802-728-4466
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Fax | 802-728-4197
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Authorized Official
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Title or Position | CFO
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Name | TIMOTHY A ROSS
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Credential |
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Telephone | 802-728-4466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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Taxonomy #5
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number |
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Taxonomy #6
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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Taxonomy #7
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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Taxonomy #8
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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