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General NPI Number Information
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NPI Number | 1891333233
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Entity Type | Individual
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Provider Name | ROSE PONEY LCMHC
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Gender | Female
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Dates
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Enumeration Date | 12/17/2019
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 1070 W MAIN ST
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City | RICHMOND
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State | VT
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Zip | 05477-9850
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Country | US
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Telephone | 802-310-0770
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Fax |
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Provider Business Mailing Address
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Address Line | 548 MOUNTAINVIEW DR
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City | WATERBURY
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State | VT
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Zip | 05676-9122
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Country | US
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Telephone | 802-310-0770
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 068.0135071
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License Number State | VT
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