Provider Demographics
NPI:1851563977
Name:WINSTON L. PROUTY CENTER FOR CHILD DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:WINSTON L. PROUTY CENTER FOR CHILD DEVELOPMENT, INC.
Other - Org Name:WINSTON PROUTY FAMILY, INFANT AND TODDLER PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHLOE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEAREY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MPH
Authorized Official - Phone:802-257-7852
Mailing Address - Street 1:20 WINSTON PROUTY WAY
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-4481
Mailing Address - Country:US
Mailing Address - Phone:802-257-7852
Mailing Address - Fax:802-258-2413
Practice Address - Street 1:20 WINSTON PROUTY WAY
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-4481
Practice Address - Country:US
Practice Address - Phone:802-257-7852
Practice Address - Fax:802-258-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1005993Medicaid