Provider Demographics
NPI:1114008828
Name:HANLEY, JANE (LCMHC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:HANLEY
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 1:183 BEARLY HI WAY
Mailing Address - Street 2:
Mailing Address - City:KILLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05701
Mailing Address - Country:US
Mailing Address - Phone:802-422-3271
Mailing Address - Fax:
Practice Address - Street 1:7 COURT SQ
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4030
Practice Address - Country:US
Practice Address - Phone:802-775-4388
Practice Address - Fax:802-775-3307
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000203101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00029298OtherBCBS
VT1007270Medicaid