Organization
CLARA MARTIN CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY A ROSS (CFO)
(802) 728-4466
Entity
Organization
Contact information
Practice address
11 S MAIN ST, RANDOLPH, VT 05060-1330
(802) 728-4466
(802) 728-4197
Mailing address
PO BOX G, RANDOLPH, VT 05060-0167
(802) 728-4466
(802) 728-4197
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QP0905X
State or Local Public Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00006178
—
VT
01
—
00800321
BLUE CROSS
VT
05
—
1003145
—
VT
05
—
1006421
—
VT
05
—
1007256
—
VT
05
—
1009814
—
VT
05
—
1009815
—
VT
01
—
1027774
CIGNA
VT
01
—
50Y083800VT01
ANTHEM
VT
01
—
63909
MVP
VT
01
—
63909A
MVP
VT
01
—
63909C
MVP
VT
01
—
93909
MVP
VT
01
—
93909A
MVP
VT
01
—
93909C
MVP
VT
01
—
T000381
TRICARE
VT
01
—
VT6178
BLUE CROSS
VT
Enumeration date
11/28/2006
Last updated
09/16/2025
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