Provider Demographics
NPI:1679882351
Name:NEW ENGLAND COUNSELING AND TRAUMA ASSOCIATE
Entity Type:Organization
Organization Name:NEW ENGLAND COUNSELING AND TRAUMA ASSOCIATE
Other - Org Name:THE NEW ENGLAND COUNSELING AND TRAUMA CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER, LLC
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LEOMBRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LCMHC
Authorized Official - Phone:802-878-4990
Mailing Address - Street 1:25 WENTWORTH DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495
Mailing Address - Country:US
Mailing Address - Phone:802-878-4990
Mailing Address - Fax:802-878-1477
Practice Address - Street 1:25 WENTWORTH DRIVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495
Practice Address - Country:US
Practice Address - Phone:802-878-4990
Practice Address - Fax:802-878-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000287101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty