Institute of Trauma Recovery and Resiliency

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

INSTITUTE OF TRAUMA RECOVERY AND RESILIENCY

Practice address

162 Hegeman Ave
Colchester, VT 05446-3109

Phone

(802) 281-3330

NPI assigned

Sep 5, 2021

Last updated

Sep 5, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Joseph Corbally, LICSWNPI 1225584980

Title

Co Director

Phone

(802) 281-3330

Specialties & licenses 2

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charles Joseph Corbally, LICSW

  • Clinical Social Worker
  • Burlington, VT
  • NPI 1225584980
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630800000000",
    "number": "1093483851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 SMUGGLERS VIEW RD",
            "city": "JEFFERSONVILLE",
            "state": "VT",
            "postal_code": "054649450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 HEGEMAN AVE",
            "city": "COLCHESTER",
            "state": "VT",
            "postal_code": "054463109",
            "telephone_number": "802-281-3330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE OF TRAUMA RECOVERY AND RESILIENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-05",
        "last_updated": "2021-09-05",
        "certification_date": "2021-09-05",
        "status": "A",
        "authorized_official_last_name": "CORBALLY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "CO DIRECTOR",
        "authorized_official_telephone_number": "802-281-3330",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1028428",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas Hunter, PSYCHOLOGIST- MASTER
• Caitlin Dorka Hutchins, PT, DPT
• Christopher Ingvoldstad, APRN, FNP-BC
• Injury & Health Management Solutions Inc.
• Inspire Physical Therapy PLC
• Ivf Laboratories of Vermont, LLC (Ovation Fertility)
• Sarah Elizabeth Jacobs Trombley, OTR
• Alicia A Jacobs, M.D.
• Susan Diana Jacques, M.S. N. A.P.R.N.
• Sharon Jendrazak, O.T.R.

• Clinical Social Worker in Colchester, VT
• Providers in Colchester, VT by specialty
• Clinical Social Worker in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.