Provider Demographics
NPI:1225613714
Name:JEWETT, TREVOR JAMES (MA)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:JAMES
Last Name:JEWETT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 FAIRFIELD ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1798
Mailing Address - Country:US
Mailing Address - Phone:802-752-7406
Mailing Address - Fax:
Practice Address - Street 1:67 FAIRFIELD ST STE 204
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1798
Practice Address - Country:US
Practice Address - Phone:802-752-7406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
VT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional