1396752994 NPI number — MS. JENNIFER ANN AULETTA MA, LCMHC, DTR

Table of content: MS. JENNIFER ANN AULETTA MA, LCMHC, DTR (NPI 1396752994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396752994 NPI number — MS. JENNIFER ANN AULETTA MA, LCMHC, DTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AULETTA
Provider First Name:
JENNIFER
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LCMHC, DTR
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:
1396752994
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
148 BARRE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTPELIER
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05602-3671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-279-5809
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CVMC, OB/GYN/MIDWIFERY, BLDG A, SUITE 1-4
Provider Second Line Business Practice Location Address:
130 FISHER ROAD
Provider Business Practice Location Address City Name:
BARRE
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05641-4124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-371-5961
Provider Business Practice Location Address Fax Number:
802-371-5960
Provider Enumeration Date:
08/03/2006

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:  068.0000665 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 068-0000665 , 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)

  • Identifier: 2080 . This is a "BLUEPRINT FOR HEALTH" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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