Provider Demographics
NPI:1760815443
Name:WALDRON, SHAWN M (MA, LCMHC, LADC, NCC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:M
Last Name:WALDRON
Suffix:
Gender:M
Credentials:MA, LCMHC, LADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:VT
Mailing Address - Zip Code:05867-9705
Mailing Address - Country:US
Mailing Address - Phone:802-745-9567
Mailing Address - Fax:802-533-2044
Practice Address - Street 1:45 CENTER ST
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:VT
Practice Address - Zip Code:05867-9705
Practice Address - Country:US
Practice Address - Phone:802-745-9567
Practice Address - Fax:802-533-2044
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000644101YA0400X
VT0680069442101YM0800X
VT151.0127299101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH31014778Medicaid
VT1022126Medicaid