Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 068-0115765 | VT |
N | 101YS0200X | School Counselor |
NPI | 1013050293 |
---|---|
Provider Name | Cynthia Gogan |
First Address | Bennington, VT 05201-0588 |
Second Address | Bennington, VT 05201-2273 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 20/07/2017 |