Provider Demographics
NPI:1083639066
Name:AUSTIN, MARION PFOST (MA,LCMHC)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:PFOST
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MA,LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-5004
Mailing Address - Country:US
Mailing Address - Phone:802-775-5060
Mailing Address - Fax:802-775-9698
Practice Address - Street 1:29 MADISON ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-5004
Practice Address - Country:US
Practice Address - Phone:802-775-5060
Practice Address - Fax:802-775-9698
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007047Medicaid