# RIVER'S EDGE INTEGRATIVE MEDICINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639873839
- **Authorized official:** CARLENE VASQUEZ-BROWN (OWNER/MEMBER)
- **Authorized official phone:** (802) 744-7284

## Contact information

- **Practice address:** 4374 RT 100, WARREN, VT 05674-0567
- **Practice address phone:** (802) 744-7284
- **Mailing address:** 4372 VERMONT ROUTE 100, WARREN, VT 05674-9728
- **Mailing address phone:** (603) 783-6714
- **Mailing address fax:** (949) 437-3084

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 03/30/2023
- **Last updated:** 03/30/2023