Basic Information
| Provider Information | |||||||||
| NPI: | 1225260672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NASUTA | ||||||||
| FirstName: | MARILYN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LCMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 320 | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056670320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024548336 | ||||||||
| FaxNumber: | 8024548339 | ||||||||
| Practice Location | |||||||||
| Address1: | 157 TOWNE AVE. | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056670320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024548336 | ||||||||
| FaxNumber: | 8024548339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2009 | ||||||||
| LastUpdateDate: | 08/19/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 068-0000343 | VT | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 068-0000343 | 01 | VT | LICENSE | OTHER |