Provider Demographics
NPI:1235416371
Name:CASTONGUAY, JENNIFER L (LCMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:CASTONGUAY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:PUIIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHC
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-0686
Mailing Address - Country:US
Mailing Address - Phone:802-595-0120
Mailing Address - Fax:802-559-0124
Practice Address - Street 1:12 RIVER ST UNIT 104
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3628
Practice Address - Country:US
Practice Address - Phone:802-559-0120
Practice Address - Fax:802-559-0124
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0057801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1019925Medicaid