1831236439 NPI number — MS. FRANCES CLARE GONTER-GROSS LADC, LCMHC

Table of content: MS. FRANCES CLARE GONTER-GROSS LADC, LCMHC (NPI 1831236439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831236439 NPI number — MS. FRANCES CLARE GONTER-GROSS LADC, LCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONTER-GROSS
Provider First Name:
FRANCES
Provider Middle Name:
CLARE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LADC, 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:
1831236439
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 FORREST AVE
Provider Second Line Business Mailing Address:
PO BOX 1336
Provider Business Mailing Address City Name:
DERBY LINE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 SEYMOUR LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-334-5246
Provider Business Practice Location Address Fax Number:
802-334-1093
Provider Enumeration Date:
01/31/2007

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: 101Y00000X , with the licence number:  068-0000554 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101Y00000X , with the licence number: 000087 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0029178 . This is a "BCBS-LADC" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1008143 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0058287 . This is a "BCBS-LCMHC" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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