Provider Demographics
NPI:1629705728
Name:MADDIE SIVO COUNSELING LLC
Entity type:Organization
Organization Name:MADDIE SIVO COUNSELING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVO
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-493-6179
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-0264
Mailing Address - Country:US
Mailing Address - Phone:802-316-8799
Mailing Address - Fax:
Practice Address - Street 1:408 HINESBURG RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:VT
Practice Address - Zip Code:05445-9380
Practice Address - Country:US
Practice Address - Phone:802-425-2771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty