Provider Demographics
NPI:1033881214
Name:YANNICK CHASSEREAU, LPMA
Entity type:Organization
Organization Name:YANNICK CHASSEREAU, LPMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:YANNICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHASSEREAU
Authorized Official - Suffix:
Authorized Official - Credentials:LPMA
Authorized Official - Phone:802-578-5469
Mailing Address - Street 1:125 HEINEBERG RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-2515
Mailing Address - Country:US
Mailing Address - Phone:802-578-5469
Mailing Address - Fax:
Practice Address - Street 1:444 S UNION ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4859
Practice Address - Country:US
Practice Address - Phone:802-578-5469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty