Individual
SHAWN MOLINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
235 LAKEMONT RD, NEWPORT, VT 05855-9507
(802) 624-4016
Mailing address
235 LAKEMONT RD, NEWPORT, VT 05855-9507
(802) 624-4016
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
S95
VT
175T00000X
Peer Specialist
Primary
S92
VT
175T00000X
Peer Specialist
S93
VT
175T00000X
Peer Specialist
S94
VT
Other
Enumeration date
12/03/2024
Last updated
12/03/2024
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