Provider Demographics
NPI:1841781218
Name:STANTON, RYAN TIMOTHY (LICSW, LADC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:TIMOTHY
Last Name:STANTON
Suffix:
Gender:M
Credentials:LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 NORTHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3333
Mailing Address - Country:US
Mailing Address - Phone:802-249-7260
Mailing Address - Fax:
Practice Address - Street 1:132 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602
Practice Address - Country:US
Practice Address - Phone:802-489-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-11-15
Deactivation Date:2018-09-26
Deactivation Code:
Reactivation Date:2018-11-15
Provider Licenses
StateLicense IDTaxonomies
VT151.0124675101YA0400X
VT089.00846531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)