Provider Demographics
NPI:1508543174
Name:BRAIN INJURY ALLIANCE OF VERMONT
Entity Type:Organization
Organization Name:BRAIN INJURY ALLIANCE OF VERMONT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-244-6850
Mailing Address - Street 1:1 DERBY LN STE 2
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-8926
Mailing Address - Country:US
Mailing Address - Phone:802-244-6850
Mailing Address - Fax:
Practice Address - Street 1:1 DERBY LN STE 2
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-8926
Practice Address - Country:US
Practice Address - Phone:802-244-3850
Practice Address - Fax:802-244-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-05
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management