Provider Demographics
NPI:1619214574
Name:CAROLINE TASSEY PLC
Entity type:Organization
Organization Name:CAROLINE TASSEY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:802-318-1907
Mailing Address - Street 1:33 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-2621
Mailing Address - Country:US
Mailing Address - Phone:802-598-4006
Mailing Address - Fax:802-316-4208
Practice Address - Street 1:1205 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05408-2804
Practice Address - Country:US
Practice Address - Phone:802-489-5665
Practice Address - Fax:802-419-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-12
Last Update Date:2015-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0016244363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTONP0855Medicaid