Provider Demographics
NPI:1093091449
Name:DALTRY, MELISSA M (LCMHC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:DALTRY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CHERRY ST
Mailing Address - Street 2:SUITE 1-5
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3938
Mailing Address - Country:US
Mailing Address - Phone:802-236-2873
Mailing Address - Fax:
Practice Address - Street 1:110 CHERRY ST
Practice Address - Street 2:SUITE 1-5
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3938
Practice Address - Country:US
Practice Address - Phone:802-236-2873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0057449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1019860Medicaid