Provider Demographics
NPI:1215092242
Name:TREE, AMY MAXINE (MACP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MAXINE
Last Name:TREE
Suffix:
Gender:F
Credentials:MACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MAIN ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5216
Mailing Address - Country:US
Mailing Address - Phone:802-651-7517
Mailing Address - Fax:802-860-1234
Practice Address - Street 1:3 MAIN ST
Practice Address - Street 2:SUITE 216
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5216
Practice Address - Country:US
Practice Address - Phone:802-651-7517
Practice Address - Fax:802-860-1234
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2009-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0470000679103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007293Medicaid
VT2076328OtherCIGNA
VT39584OtherBCBS
191313000OtherMAGELLAN BEHAVIORAL HEALT
559398OtherVALUE OPTIONS
300215965OtherUNITED BEHAVIORAL HEALTH