Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 000007 | VT |
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 048-0000396 | VT |
NPI | 1255369237 |
---|---|
Provider Name | Anthony R Quintiliani |
First Address | North Ferrisburg, VT 05473-0088 |
Second Address | Burlington, VT 05401-5301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 12/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1007288 | (05) | VT |