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125 College St Ste 3 Burlington VT 05401-8444 | |
| (802) 863-2495 | |
| (802) 865-0534 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 125 College St Ste 3, Burlington, Vermont |
| Authorized Official Name and Position | David S Ganapol (DIRECTOR) |
| Authorized Official Contact | 8028632495 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 581 Burlington VT 05402-0581 Ph: (802) 863-2495 | 125 College St Ste 3 Burlington VT 05401-8444 Ph: (802) 863-2495 |
| NPI Number | 1912046764 |
|---|---|
| Provider Enumeration Date | 02/06/2007 |
| Last Update Date | 02/20/2024 |
| Certification Date | 02/13/2024 |
| Medicare PECOS PAC ID | 2062502123 |
|---|---|
| Medicare Enrollment ID | O20080117000324 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912046764 | NPI | - | NPPES |
| OVN1852 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jason S Frishman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083883045 PECOS PAC ID: 7315018827 Enrollment ID: I20080611000165 |
| Provider Name | David S Ganapol |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750699351 PECOS PAC ID: 2668617184 Enrollment ID: I20130403000407 |
| Provider Name | Meredith H. Ozier |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457634156 PECOS PAC ID: 1456893981 Enrollment ID: I20240715002057 |
| Provider Name | Red Hart-smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992276281 PECOS PAC ID: 0547702078 Enrollment ID: I20240807004197 |
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