Provider Demographics
NPI:1154191104
Name:TWOMBLY, ASA PETTENGILL (MA)
Entity type:Individual
Prefix:
First Name:ASA
Middle Name:PETTENGILL
Last Name:TWOMBLY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05669-0048
Mailing Address - Country:US
Mailing Address - Phone:802-595-3532
Mailing Address - Fax:
Practice Address - Street 1:1400 BRAINTREE HILL RD.
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:VT
Practice Address - Zip Code:05669
Practice Address - Country:US
Practice Address - Phone:802-595-3532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health