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General NPI Number Information
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NPI Number | 1578177051
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Entity Type | Organization
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Legal Business Name | SERENITY MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 1815 VT RTE 15
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City | WOLCOTT
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State | VT
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Zip | 05680-3008
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Country | US
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Telephone | 802-696-9830
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Fax | 802-888-2369
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Provider Business Mailing Address
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Address Line | PO BOX 1002
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City | WOLCOTT
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State | VT
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Zip | 05680-1002
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Country | US
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Telephone | 802-696-9830
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Fax | 802-888-2369
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DANIELLE LERICHE-FORKEY
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Credential | MA
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Telephone | 802-696-9830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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