Provider Demographics
NPI:1326127366
Name:THE ADAMS CENTER FOR MIND & BODY LLC
Entity Type:Organization
Organization Name:THE ADAMS CENTER FOR MIND & BODY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:N
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MA LICENSE PSYCH MST
Authorized Official - Phone:802-859-1577
Mailing Address - Street 1:1233 SHELBURNE RD
Mailing Address - Street 2:PIERSON HOUSE 0 2
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403
Mailing Address - Country:US
Mailing Address - Phone:802-859-1577
Mailing Address - Fax:802-859-1571
Practice Address - Street 1:1233 SHELBURNE RD
Practice Address - Street 2:PIERSON HOUSE 0 2
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-859-1577
Practice Address - Fax:802-859-1571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0470000633103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty