Provider Demographics
NPI:1730560533
Name:VIDANA, LORREN J (LCMHC)
Entity type:Individual
Prefix:MS
First Name:LORREN
Middle Name:J
Last Name:VIDANA
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1211
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05402-1211
Mailing Address - Country:US
Mailing Address - Phone:857-261-8017
Mailing Address - Fax:888-690-3679
Practice Address - Street 1:1 STEELE ST STE 119
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-6205
Practice Address - Country:US
Practice Address - Phone:857-261-8017
Practice Address - Fax:888-690-3679
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134861101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health