Provider Demographics
NPI:1326074949
Name:PADILLA, TERRY GWEN (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:GWEN
Last Name:PADILLA
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 MINISTER BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05682-9760
Mailing Address - Country:US
Mailing Address - Phone:802-229-4597
Mailing Address - Fax:716-809-3774
Practice Address - Street 1:100 STATE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3099
Practice Address - Country:US
Practice Address - Phone:802-229-4597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000103101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011085Medicaid