Provider Demographics
NPI:1053439950
Name:MORAN, JOHN T (MA, LADC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:MORAN
Suffix:
Gender:M
Credentials:MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL CT
Mailing Address - Street 2:STE 410
Mailing Address - City:BELLOWS FALLS
Mailing Address - State:VT
Mailing Address - Zip Code:05101-1489
Mailing Address - Country:US
Mailing Address - Phone:802-463-3294
Mailing Address - Fax:802-463-1206
Practice Address - Street 1:51 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6629
Practice Address - Country:US
Practice Address - Phone:802-254-6028
Practice Address - Fax:802-254-7501
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000169103T00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT29256OtherBLUE CROSS D&A
VT49392OtherBLUE CROSS