Provider Demographics
NPI:1558748012
Name:INDORF, RALPH (LCMHC)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:INDORF
Suffix:
Gender:M
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:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05037-0316
Mailing Address - Country:US
Mailing Address - Phone:802-952-9017
Mailing Address - Fax:
Practice Address - Street 1:5 S MAIN ST STE 318
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-7416
Practice Address - Country:US
Practice Address - Phone:802-952-9017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1991101YM0800X
VT068.0134102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE2534Medicare PIN