Provider Demographics
NPI:1386710861
Name:CLARA MARTIN CENTER
Entity type:Organization
Organization Name:CLARA MARTIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. QUALITY ASSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIDNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-728-4466
Mailing Address - Street 1:PO BOX G
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060
Mailing Address - Country:US
Mailing Address - Phone:802-728-4466
Mailing Address - Fax:802-728-4197
Practice Address - Street 1:11 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1330
Practice Address - Country:US
Practice Address - Phone:802-728-4466
Practice Address - Fax:802-728-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or LocalGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1003145Medicaid
VTT000381OtherTRICARE
VTVT6178OtherBLUE CROSS
VT63909COtherMVP
VT93909AOtherMVP
VT93909OtherMVP
VT1007256Medicaid
VT1009814Medicaid
VT1027774OtherCIGNA
VT00800321OtherBLUE CROSS
VT1009815Medicaid
VT63909AOtherMVP
VT00006178Medicaid
VT1006421Medicaid
VT50Y083800VT01OtherANTHEM
VT63909OtherMVP
VT93909COtherMVP
VT63909AOtherMVP
VT00006178Medicaid