Provider Demographics
NPI:1093961278
Name:ZAANTI PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:ZAANTI PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER OF LLC
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUSHFORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:802-658-4208
Mailing Address - Street 1:34 PATCHEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-5704
Mailing Address - Country:US
Mailing Address - Phone:802-658-4208
Mailing Address - Fax:802-658-2234
Practice Address - Street 1:34 PATCHEN RD
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-5704
Practice Address - Country:US
Practice Address - Phone:802-658-4208
Practice Address - Fax:802-658-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000735103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1015031Medicaid