Provider Demographics
NPI:1184590994
Name:MAYBECK, JARED WALTER
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:WALTER
Last Name:MAYBECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-4116
Mailing Address - Country:US
Mailing Address - Phone:802-234-1429
Mailing Address - Fax:
Practice Address - Street 1:30 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-4116
Practice Address - Country:US
Practice Address - Phone:802-234-1429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0135786101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health