MEDICARE: JENNIFER ELIZABETH COKE MA 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	101YP2500X	Professional Counselor	097.0134958	VT
2	172V00000X	Community Health Worker
3	101YM0800X	Mental Health Counselor	068.0136565	VT

General Provider Information

NPI Number	:	1962008581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ELIZABETH COKE MA LCMHC

Provider Business Mailing Address
First Line	:	390 RIVER STREET
Second Line	:
City	:	SPRINGFIELD
State	:	VT
Zip	:	05156-2226
Country	:	US
Telephone Number	:	802-886-4500
Fax Number	:	802-886-4560

Provider Business Practice Location Address
First Line	:	51 FAIRVIEW STREET
Second Line	:
City	:	BRATTLEBORO
State	:	VT
Zip	:	05301-4809
Country	:	US
Telephone Number	:	802-254-6028
Fax Number	:	802-254-7501

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

Provider Enumeration Date	:	12/09/2020
Last Update Date	:	04/14/2025

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