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General NPI Number Information
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NPI Number | 1588498026
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Entity Type | Organization
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Legal Business Name | ANGEL ROY LLC
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Dates
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Enumeration Date | 08/28/2024
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 231 CONCORD AVE
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City | ST JOHNSBURY
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State | VT
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Zip | 05819-1515
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Country | US
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Telephone | 802-748-5364
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Fax |
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Provider Business Mailing Address
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Address Line | 544 ANDERSON ST
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City | BARNET
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State | VT
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Zip | 05821-9652
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Country | US
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Telephone | 802-249-1513
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGEL ROY
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Credential | LCMHS
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Telephone | 802-249-1513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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