Provider Demographics
NPI:1477114668
Name:NORTHERN FOREST PSYCHOTHERAPY
Entity Type:Organization
Organization Name:NORTHERN FOREST PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEVELOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-527-6380
Mailing Address - Street 1:414 BUTTERNUT RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7303
Mailing Address - Country:US
Mailing Address - Phone:828-527-6380
Mailing Address - Fax:
Practice Address - Street 1:346 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4935
Practice Address - Country:US
Practice Address - Phone:828-527-6380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty