Provider Demographics
NPI:1659475333
Name:CASEIRO, MARYBETH (MS)
Entity type:Individual
Prefix:MS
First Name:MARYBETH
Middle Name:
Last Name:CASEIRO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6589
Mailing Address - Country:US
Mailing Address - Phone:802-258-4758
Mailing Address - Fax:802-254-7388
Practice Address - Street 1:229 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6589
Practice Address - Country:US
Practice Address - Phone:802-258-4758
Practice Address - Fax:802-254-7388
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000342101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010008Medicaid
NH30422892Medicaid