MEDICARE: PLUM THERAPY, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1841060233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLUM THERAPY, LLC

Provider Business Mailing Address
First Line	:	23 GRANDVIEW AVE
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-3008
Country	:	US
Telephone Number	:	802-310-5675
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 GRANDVIEW AVE
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-3008
Country	:	US
Telephone Number	:	802-310-5675
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATRINA SLIWKA
Credential	:	LCMHC
Telephone Number	:	802-310-5675

Provider Enumeration Date	:	01/05/2024
Last Update Date	:	01/05/2024

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Directions to “PLUM THERAPY, LLC ” Practice Location

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