Provider Demographics
| NPI: | 1427104132 |
|---|---|
| Name: | UNITED COUNSELING SERVICE OF BENNINGTON COUNTY, INC. |
| Entity type: | Organization |
| Organization Name: | UNITED COUNSELING SERVICE OF BENNINGTON COUNTY, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | LORNA |
| Authorized Official - Middle Name: | W |
| Authorized Official - Last Name: | MATTERN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 802-442-5491 |
| Mailing Address - Street 1: | PO BOX 588 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BENNINGTON |
| Mailing Address - State: | VT |
| Mailing Address - Zip Code: | 05201-0588 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 100 LEDGEHILL RD |
| Practice Address - Street 2: | |
| Practice Address - City: | BENNINGTON |
| Practice Address - State: | VT |
| Practice Address - Zip Code: | 05201-2273 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 802-442-5491 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-01-26 |
| Last Update Date: | 2019-05-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | |
| No | 251B00000X | Agencies | Case Management | |
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
| No | 251S00000X | Agencies | Community/Behavioral Health | |
| No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
| No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
| No | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| VT | 1009769 | Medicaid | |
| VT | 6030008 | Medicaid | |
| VT | 7010136 | Other | AETNA |
| VT | 1007294 | Medicaid | |
| VT | 1007386 | Medicaid | |
| VT | 1006426 | Medicaid | |
| 261642 | Other | MASS BLUE CROSS | |
| 1765 | Other | CDPHP | |
| VT | 047W088 | Medicaid | |
| VT | 1015699 | Medicaid | |
| 2032392 | Other | CIGNA | |
| VT | 1005330 | Medicaid | |
| VT | 1009768 | Medicaid | |
| VT | 6139 | Other | VT BLUE CROSS |
| 073487 | Other | VALUE OPTIONS | |
| 341565 | Other | TRICARE | |
| 63941 | Other | MVP | |
| VT | 0006139 | Medicaid | |
| VT | 1001095 | Medicaid | |
| VT | 6139 | Other | VT BLUE CROSS |
