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General NPI Number Information
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NPI Number | 1629705728
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Entity Type | Organization
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Legal Business Name | MADDIE SIVO COUNSELING LLC
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 408 HINESBURG RD
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City | CHARLOTTE
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State | VT
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Zip | 05445-9380
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Country | US
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Telephone | 802-425-2771
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 264
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City | WILLISTON
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State | VT
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Zip | 05495-0264
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Country | US
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Telephone | 802-316-8799
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. MADELINE SIVO
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Credential | LICSW
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Telephone | 603-493-6179
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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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