Provider Demographics
NPI:1699103069
Name:CARRIVEAU, JASON (PMHNP-BC, RN, ATC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:CARRIVEAU
Suffix:
Gender:M
Credentials:PMHNP-BC, RN, ATC
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 38
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-0038
Mailing Address - Country:US
Mailing Address - Phone:802-498-8123
Mailing Address - Fax:802-448-5637
Practice Address - Street 1:28 PARK AVE STE 100
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-9701
Practice Address - Country:US
Practice Address - Phone:802-793-8636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0135812363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health