Provider Demographics
NPI:1831081702
Name:JEAN, ALIVIA (BA)
Entity type:Individual
Prefix:
First Name:ALIVIA
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:ALIVIA
Other - Middle Name:
Other - Last Name:TACELLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:390 RIVER STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156
Mailing Address - Country:US
Mailing Address - Phone:802-886-4500
Mailing Address - Fax:802-886-4520
Practice Address - Street 1:330 LINDEN STREET
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301
Practice Address - Country:US
Practice Address - Phone:802-275-4971
Practice Address - Fax:802-490-2378
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker