Provider Demographics
NPI:1891333233
Name:PONEY, ROSE (LCMHC)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:PONEY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 MOUNTAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-9122
Mailing Address - Country:US
Mailing Address - Phone:802-310-0770
Mailing Address - Fax:
Practice Address - Street 1:1070 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VT
Practice Address - Zip Code:05477-9850
Practice Address - Country:US
Practice Address - Phone:802-310-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0135071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health