Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 261Q00000X | Clinic/Center | | | | No |
| 2 | 261QM0855X | Clinic/Center | Adolescent and Children Mental Health | | | No |
| 3 | 261QM0850X | Clinic/Center | Adult Mental Health | | | No |
| 4 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | | | No |
| 5 | 251C00000X | Day Training, Developmentally Disabled Services | | | | No |
| 6 | 261QD1600X | Clinic/Center | Developmental Disabilities | | | No |
| 7 | 310400000X | Assisted Living Facility | | | | No |
| 8 | 320800000X | Community Based Residential Treatment Facility, Mental Illness | | | | No |
| 9 | 315P00000X | Intermediate Care Facility, Intellectual Disabilities | | | | No |
| 10 | 251K00000X | Public Health or Welfare | | | | No |
| 11 | 251S00000X | Community/Behavioral Health | | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 2050939 | OTHER | VERMONT | CIGNA |
| 2 | 491116 | OTHER | VERMONT | VALUE OPTIONS |
| 3 | 1001094 | MEDICAID | VERMONT | |
| 4 | CN7031 | OTHER | VERMONT | RR MEDICARE |
| 5 | 0006103 | MEDICAID | VERMONT | |
| 6 | 355023 | OTHER | VERMONT | MHN |
| 7 | 66316 | OTHER | VERMONT | MVP |
| 8 | 1009767 | MEDICAID | VERMONT | |
| 9 | FRAN6103 | OTHER | VERMONT | BCBS |
| 10 | 1006629 | MEDICAID | VERMONT | |
| 11 | 1007307 | MEDICAID | VERMONT | |
| 12 | VT6103 | MEDICARE PIN | VERMONT | |
| 13 | 1006428 | MEDICAID | VERMONT | |
| 14 | 1009766 | MEDICAID | VERMONT | |
| 15 | 1006107 | MEDICAID | VERMONT | |
