Provider Demographics
NPI:1811326549
Name:HENRY, GENEVIEVE (CMT, CD)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:CMT, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MAIN ST STE 214
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8480
Mailing Address - Country:US
Mailing Address - Phone:802-373-3236
Mailing Address - Fax:
Practice Address - Street 1:1 MAIN ST STE 214
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8480
Practice Address - Country:US
Practice Address - Phone:802-373-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
VT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist