Provider Demographics
NPI:1881038693
Name:VERMONT EDUCATIONAL SUPPORT ASSOCIATES, INC.
Entity Type:Organization
Organization Name:VERMONT EDUCATIONAL SUPPORT ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:802-775-6331
Mailing Address - Street 1:1085 US ROUTE 4
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701
Mailing Address - Country:US
Mailing Address - Phone:802-775-6331
Mailing Address - Fax:802-775-6373
Practice Address - Street 1:1085 US ROUTE 4 E
Practice Address - Street 2:SUITE 2A
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701
Practice Address - Country:US
Practice Address - Phone:802-775-6331
Practice Address - Fax:802-775-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT196103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6565Medicaid