Provider Demographics
NPI:1154579225
Name:DEPAUL, ANTHONY (MA)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:DEPAUL
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 1:1089 CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:VT
Mailing Address - Zip Code:05661-4481
Mailing Address - Country:US
Mailing Address - Phone:802-355-5550
Mailing Address - Fax:802-888-2244
Practice Address - Street 1:39 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843
Practice Address - Country:US
Practice Address - Phone:802-472-6694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0066612101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health