Basic Information
Provider Information | |||||||||
NPI: | 1093005092 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HOWARDCENTER, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | TWIN OAKS COUNSELING SERVICES | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 208 FLYNN AVE STE 3J | ||||||||
Address2: |   | ||||||||
City: | BURLINGTON | ||||||||
State: | VT | ||||||||
PostalCode: | 054015420 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8024886900 | ||||||||
FaxNumber: | 8024886901 | ||||||||
Practice Location | |||||||||
Address1: | 75 SAN REMO DR | ||||||||
Address2: |   | ||||||||
City: | SOUTH BURLINGTON | ||||||||
State: | VT | ||||||||
PostalCode: | 054036385 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8024887350 | ||||||||
FaxNumber: | 8024886919 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/11/2011 | ||||||||
LastUpdateDate: | 11/18/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MCGUIRE | ||||||||
AuthorizedOfficialFirstName: | SANDY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR, ADMIN & FINANCE | ||||||||
AuthorizedOfficialTelephone: | 8024886900 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | HOWARDCENTER | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.