Provider Demographics
NPI:1265446835
Name:WASHINGTON COUNTY MENTAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:WASHINGTON COUNTY MENTAL HEALTH SERVICES, INC.
Other - Org Name:COMMUNITY DEVELOPMENTAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-229-0591
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-0647
Mailing Address - Country:US
Mailing Address - Phone:802-229-0591
Mailing Address - Fax:802-223-3667
Practice Address - Street 1:50 GRANVIEW DR
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-5113
Practice Address - Country:US
Practice Address - Phone:802-479-2502
Practice Address - Fax:802-479-4056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1001092Medicaid