Provider Demographics
NPI:1215003926
Name:ORLEANS N ESSEX FAMILY INFANT & TODDLER
Entity Type:Organization
Organization Name:ORLEANS N ESSEX FAMILY INFANT & TODDLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-334-5847
Mailing Address - Street 1:338 HIGHLAND AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855
Mailing Address - Country:US
Mailing Address - Phone:802-334-3324
Mailing Address - Fax:802-334-2047
Practice Address - Street 1:338 HIGHLAND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-4866
Practice Address - Country:US
Practice Address - Phone:802-334-3324
Practice Address - Fax:802-334-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006142Medicaid