Provider Demographics
NPI:1790302552
Name:HERRICK, NEIL (MA)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:HERRICK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 CEDAR HILL LN APT 12
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3546
Mailing Address - Country:US
Mailing Address - Phone:802-730-4676
Mailing Address - Fax:
Practice Address - Street 1:97 CEDAR HILL LN APT 12
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3546
Practice Address - Country:US
Practice Address - Phone:802-730-4676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-28
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health