Basic Information
Provider Information | |||||||||
NPI: | 1649691452 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CASTONGUAY | ||||||||
FirstName: | ERIC | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCMHC, LPCC, MHC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 170 MIDDLE RD N | ||||||||
Address2: |   | ||||||||
City: | MIDDLEBURY | ||||||||
State: | VT | ||||||||
PostalCode: | 057538609 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8027608214 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 170 MIDDLE RD N UNIT 1 | ||||||||
Address2: |   | ||||||||
City: | MIDDLEBURY | ||||||||
State: | VT | ||||||||
PostalCode: | 057538609 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8027608214 | ||||||||
FaxNumber: | 8024886919 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/20/2013 | ||||||||
LastUpdateDate: | 08/09/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/09/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 068-0131630 | VT | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.