Provider Demographics
NPI:1528273851
Name:GIROUX, MARY-ELLEN (MA)
Entity type:Individual
Prefix:MS
First Name:MARY-ELLEN
Middle Name:
Last Name:GIROUX
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3235
Mailing Address - Country:US
Mailing Address - Phone:802-878-7126
Mailing Address - Fax:802-878-9966
Practice Address - Street 1:67 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3235
Practice Address - Country:US
Practice Address - Phone:802-878-7126
Practice Address - Fax:802-878-9966
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT614103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007101Medicaid