Provider Demographics
NPI:1275753543
Name:NOSTRANT, HEIDI M (MA)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:M
Last Name:NOSTRANT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:HEIDI
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05033-0431
Mailing Address - Country:US
Mailing Address - Phone:802-222-4200
Mailing Address - Fax:
Practice Address - Street 1:142 MAIN ST.
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033-0142
Practice Address - Country:US
Practice Address - Phone:802-222-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000709103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT59344OtherBLUE CROSS BLUE SHIELD
VT1009645Medicaid
NH30422617Medicaid