Provider Demographics
NPI:1982742714
Name:RICHTER, MARC D (LICSW, LADC, CADC)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:D
Last Name:RICHTER
Suffix:
Gender:M
Credentials:LICSW, LADC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-9281
Mailing Address - Country:US
Mailing Address - Phone:802-425-7771
Mailing Address - Fax:802-540-8199
Practice Address - Street 1:2 CHURCH ST
Practice Address - Street 2:SUITE 3G
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4299
Practice Address - Country:US
Practice Address - Phone:866-429-2074
Practice Address - Fax:802-540-8199
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000372101YA0400X
VT103704101YA0400X
VT089-00006581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN2410Medicaid