Provider Demographics
NPI:1265727812
Name:SD ASSOCIATES LLC
Entity type:Organization
Organization Name:SD ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / AGENT / CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:POWSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:802-236-0121
Mailing Address - Street 1:PO BOX 4169
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-4169
Mailing Address - Country:US
Mailing Address - Phone:802-236-0121
Mailing Address - Fax:802-315-0066
Practice Address - Street 1:4049 WILLISTON RD STE 8
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6048
Practice Address - Country:US
Practice Address - Phone:802-236-0121
Practice Address - Fax:802-315-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-12
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency