Provider Demographics
NPI:1205264124
Name:CROTEAU, THOMAS R (LCMHC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:R
Last Name:CROTEAU
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 S MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-4865
Mailing Address - Country:US
Mailing Address - Phone:802-595-3424
Mailing Address - Fax:
Practice Address - Street 1:84 S MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4865
Practice Address - Country:US
Practice Address - Phone:802-595-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0084692101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1022529Medicaid