Doctor Name: | MS. ANDREA WALDO |
NPI Number: | 1265595805 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, LCMHC |
License Number: | 068-0000331 |
Business Practice Address: | 5138 Shelburne Rd Shelburne, VT - 054826698 |
Business Phone Number: | 8023639515 |
Business Fax Number: | |
Mailing Address: | Po Box 846, SHELBURNE |
State: | VT |
Postal Code: | 054820846 |
Phone Number: | 8023639515 |
Fax Number: | |
NPI Enumeration Date: | 12/18/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 068-0000331 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |