| NPI | 1780411223 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON M CARRIVEAU Owner/Provider 802-793-8636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-09-18 |
| Last Update Date | 2024-09-18 |