Provider Demographics
NPI:1124149323
Name:COLE, STEPHEN T (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:T
Last Name:COLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 RUNNALS RD
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-9235
Mailing Address - Country:US
Mailing Address - Phone:802-356-2424
Mailing Address - Fax:
Practice Address - Street 1:43 LEBANON ST FL 2
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-2513
Practice Address - Country:US
Practice Address - Phone:802-359-2089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH686103TC0700X
VT048-0000565103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN 0682Medicaid
VTOVN 0682Medicaid