Provider Demographics
NPI:1366931412
Name:CALDWELL, AMY (NCC, LCMHC)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:NCC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 MCINTOSH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7375
Mailing Address - Country:US
Mailing Address - Phone:720-252-3437
Mailing Address - Fax:
Practice Address - Street 1:49 MCINTOSH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7375
Practice Address - Country:US
Practice Address - Phone:720-252-3437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134105101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health