Provider Demographics
NPI:1376069542
Name:SOUTH ROYALTON SCHOOL BASED HEALTH CLINIC
Entity Type:Organization
Organization Name:SOUTH ROYALTON SCHOOL BASED HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-431-6060
Mailing Address - Street 1:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:SOUTH ROYALTON
Mailing Address - State:VT
Mailing Address - Zip Code:05068-0542
Mailing Address - Country:US
Mailing Address - Phone:802-431-6060
Mailing Address - Fax:
Practice Address - Street 1:4266 VERMONT ROUTE 14
Practice Address - Street 2:
Practice Address - City:SOUTH ROYALTON
Practice Address - State:VT
Practice Address - Zip Code:05068
Practice Address - Country:US
Practice Address - Phone:802-431-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty