Provider Demographics
NPI:1699806588
Name:ENGERT, ANDREW J (LCMHC, MA)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:ENGERT
Suffix:
Gender:M
Credentials:LCMHC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 PALMER CT
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-9061
Mailing Address - Country:US
Mailing Address - Phone:802-356-9065
Mailing Address - Fax:
Practice Address - Street 1:160 PALMER CT
Practice Address - Street 2:SUITE 1D
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-9061
Practice Address - Country:US
Practice Address - Phone:802-356-9065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH714101YM0800X
VT068.0104660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid