Provider Demographics
NPI:1578177051
Name:SERENITY MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:SERENITY MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LERICHE-FORKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:802-696-9830
Mailing Address - Street 1:PO BOX 1002
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:VT
Mailing Address - Zip Code:05680-1002
Mailing Address - Country:US
Mailing Address - Phone:802-696-9830
Mailing Address - Fax:802-888-2369
Practice Address - Street 1:1815 VT RTE 15
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:VT
Practice Address - Zip Code:05680-3008
Practice Address - Country:US
Practice Address - Phone:802-696-9830
Practice Address - Fax:802-888-2369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty