MEDICARE: SUSAN B OAKES LCMHC

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
1	101YM0800X	Mental Health Counselor	068-0000548	VT

Other Identifiers

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

General Provider Information

NPI Number	:	1609805712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN B OAKES LCMHC

Provider Business Mailing Address
First Line	:	204 N WINOOSKI AVE
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05401-3618
Country	:	US
Telephone Number	:	802-355-5122
Fax Number	:

Provider Business Practice Location Address
First Line	:	855 PINE ST
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05401-4924
Country	:	US
Telephone Number	:	802-865-6123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	07/08/2007

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