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Individual

ROBERT J FORTGANG

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
MA, LCMHC

Contact information

Practice address
118 PARK ST, SPRINGFIELD, VT 05156-3030
(603) 387-4927
Mailing address
PO BOX 266, NEW HAMPTON, NH 03256-0266

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
068-0000243
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1010554
VT
Enumeration date
05/06/2006
Last updated
07/08/2007
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