Basic Information
| Provider Information | |||||||||
| NPI: | 1144467606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEMERS | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | CALDWELL | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 525 HERCULES DR STE 1A | ||||||||
| Address2: | |||||||||
| City: | COLCHESTER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054468113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022645333 | ||||||||
| FaxNumber: | 9543420273 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 HERCULES DR STE 1A | ||||||||
| Address2: | |||||||||
| City: | COLCHESTER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054468113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022645333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2009 | ||||||||
| LastUpdateDate: | 05/15/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/04/2020 | ||||||||
| NPIReactivationDate: | 05/06/2020 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 047.0133682 | VT | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.