Provider Demographics
NPI:1659406296
Name:VERMONT DEPARTMENT OF MENTAL HEALTH
Entity Type:Organization
Organization Name:VERMONT DEPARTMENT OF MENTAL HEALTH
Other - Org Name:VDH - DMH
Other - Org Type:Other Name
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:WON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-652-2045
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:108 CHERRY ST.
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05402-0070
Mailing Address - Country:US
Mailing Address - Phone:802-652-2045
Mailing Address - Fax:802-865-7754
Practice Address - Street 1:108 CHERRY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4295
Practice Address - Country:US
Practice Address - Phone:802-652-2045
Practice Address - Fax:802-865-7754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006420Medicaid