Provider Demographics
NPI:1053048793
Name:GREEN MOUNTAIN AID, INC.
Entity type:Organization
Organization Name:GREEN MOUNTAIN AID, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:REINCKE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:802-735-7934
Mailing Address - Street 1:86 SAINT PAUL ST STE 311
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4958
Mailing Address - Country:US
Mailing Address - Phone:802-753-7934
Mailing Address - Fax:
Practice Address - Street 1:86 SAINT PAUL ST STE 311
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4958
Practice Address - Country:US
Practice Address - Phone:802-753-7934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6709932Medicaid