Basic Information
| Provider Information | |||||||||
| NPI: | 1477033207 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESANCY | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 208 FLYNN AVE STE 3J | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054015420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024886920 | ||||||||
| FaxNumber: | 8024886919 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 SAN REMO DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054036385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024886900 | ||||||||
| FaxNumber: | 8024886919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2018 | ||||||||
| LastUpdateDate: | 08/21/2018 | ||||||||
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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 | 101YA0400X | 151-0134045 | VT | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.