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Provider Information for 1366810665


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CHAD BRUNET


Sex: Male

NPI: 1366810665
Last Updated: 2015-09-03
Certification Date:

Details

NameValue
NPI1366810665
Enumeration Date2015-09-03
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 215 N MAIN ST
WHITE RIVER JUNCTION, VT 05009-0001
United States

Phone: 802-295-9363 | Fax:
 
Primary Practice Address 215 N MAIN ST
WHITE RIVER JUNCTION, VT 05009-0001
United States

Phone: 802-295-9363 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)VT089.0089237VA Employee
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalVT089.0089237