Provider Demographics
NPI:1265084230
Name:MANCINELLI, SUZANNE (LMFT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:MANCINELLI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-4201
Mailing Address - Country:US
Mailing Address - Phone:802-552-8560
Mailing Address - Fax:
Practice Address - Street 1:252 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-4201
Practice Address - Country:US
Practice Address - Phone:802-552-8560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT100.0115934106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist