Provider Demographics
NPI:1235120163
Name:COTE, WILLIAM R
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:COTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 CENTER ST.
Mailing Address - Street 2:PO BOX 332
Mailing Address - City:LYNDON CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05850-0332
Mailing Address - Country:US
Mailing Address - Phone:802-626-8157
Mailing Address - Fax:802-626-4011
Practice Address - Street 1:2225 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-8635
Practice Address - Country:US
Practice Address - Phone:802-748-3181
Practice Address - Fax:802-748-0704
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT003101YA0400X
VT1010012280364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTNP0512Medicaid
VT0NO0512Medicare ID - Type Unspecified
VTNP0512Medicaid