1629091715 NPI number — JESSICA K WRIGHT LCMHC

Table of content: (NPI 1346836822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629091715 NPI number — JESSICA K WRIGHT LCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRIGHT
Provider First Name:
JESSICA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCMHC
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:
1629091715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3488 THAYER BROOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRAINTREE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05060-9201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-505-8596
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 PLEASANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANDOLPH
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05060-1265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-505-8596
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2006

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:  068-0000468 , 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: 1007326 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14Y000794VT01 . This is a "BC/BS OF NH" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 00048725 . This is a "BC/BS OF VT" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 989026C . This is a "MVP HEALTHCARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 373342 . This is a "TRICARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 2052859 . This is a "CIGNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com