Provider Demographics
NPI:1386705945
Name:HALPERIN, ELLEN B (LCMHC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:B
Last Name:HALPERIN
Suffix:
Gender:F
Credentials:LCMHC
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 159
Mailing Address - Street 2:111 MAIN ST
Mailing Address - City:HYDE PARK
Mailing Address - State:VT
Mailing Address - Zip Code:05655-0159
Mailing Address - Country:US
Mailing Address - Phone:802-888-6215
Mailing Address - Fax:802-888-9474
Practice Address - Street 1:111 MAIN ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:VT
Practice Address - Zip Code:05655-0159
Practice Address - Country:US
Practice Address - Phone:802-888-6215
Practice Address - Fax:802-888-9474
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000108101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006723Medicaid