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NPI Code Detail

MEDICARE: JESSICA I. DAMBACH M.A.

MEDICARE: JESSICA I. DAMBACH M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor0680000596VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306927447
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA I. DAMBACH M.A.
Provider Business Mailing Address
First Line : PO BOX 749
Second Line :
City : MORRISVILLE
State : VT
Zip : 05661-0749
Country : US
Telephone Number : 800-851-8603
Fax Number : 802-851-8313
Provider Business Practice Location Address
First Line : 65 NORTHGATE PLAZA
Second Line : SUITE 11
City : MORRISVILLE
State : VT
Zip : 05661-5900
Country : US
Telephone Number : 802-888-8320
Fax Number : 802-888-8136
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 05/31/2012

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