Provider Demographics
NPI:1821005398
Name:PARKER, JAYNE A (MA)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:A
Last Name:PARKER
Suffix:
Gender:F
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:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-0647
Mailing Address - Country:US
Mailing Address - Phone:802-476-1480
Mailing Address - Fax:802-479-4095
Practice Address - Street 1:260 BECKLEY HILL RD
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-9080
Practice Address - Country:US
Practice Address - Phone:802-476-1480
Practice Address - Fax:802-479-4095
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000254103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT2083883OtherCIGNA
VT0002593Medicaid
VT00002593OtherBC/BS OF VT
VTVN382201Medicare PIN