Provider Demographics
NPI:1114768330
Name:SIRONI, GIAGE PHOENIX
Entity type:Individual
Prefix:
First Name:GIAGE
Middle Name:PHOENIX
Last Name:SIRONI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 S UNION ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5070
Mailing Address - Country:US
Mailing Address - Phone:802-760-7746
Mailing Address - Fax:
Practice Address - Street 1:156 COLLEGE ST STE 205
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8423
Practice Address - Country:US
Practice Address - Phone:802-760-7746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.1036135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health