Provider Demographics
NPI:1902207988
Name:PATHWAYS VERMONT, INC.
Entity Type:Organization
Organization Name:PATHWAYS VERMONT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-492-8218
Mailing Address - Street 1:125 COLLEGE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8444
Mailing Address - Country:US
Mailing Address - Phone:888-492-8218
Mailing Address - Fax:855-362-2766
Practice Address - Street 1:279 N WINOOSKI AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3620
Practice Address - Country:US
Practice Address - Phone:888-492-8218
Practice Address - Fax:855-362-2766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1018408Medicaid
VT1023889Medicaid
VT1023890Medicaid