1104238591 NPI number — LOUISE S. BINETTE LCMHC, R-DMT

Table of content: LOUISE S. BINETTE LCMHC, R-DMT (NPI 1104238591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104238591 NPI number — LOUISE S. BINETTE LCMHC, R-DMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BINETTE
Provider First Name:
LOUISE
Provider Middle Name:
S.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCMHC, R-DMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104238591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
257 BLAIR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSTOWN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01267-3103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-884-3685
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 BENMONT AVE
Provider Second Line Business Practice Location Address:
SUITE 30
Provider Business Practice Location Address City Name:
BENNINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05201-1873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-884-3685
Provider Business Practice Location Address Fax Number:
802-447-2115
Provider Enumeration Date:
05/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0680102895 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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