Center for Trauma Recovery LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

CENTER FOR TRAUMA RECOVERY LLC

Doing business as

Center for Trauma Recovery

Practice address

523 Smugglers View Rd
Jeffersonville, VT 05464-9450

Phone

(802) 324-3792

NPI assigned

Sep 10, 2021

Last updated

Sep 10, 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 J. Corbally, LICSWNPI 1225584980

Title

Co Owner

Phone

(802) 281-3330

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Center for Trauma Recovery Doing business as

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": "1631232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631232000000",
    "number": "1841969094",
    "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",
            "telephone_number": "802-324-3792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "523 SMUGGLERS VIEW RD",
            "city": "JEFFERSONVILLE",
            "state": "VT",
            "postal_code": "054649450",
            "telephone_number": "802-324-3792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR TRAUMA RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-10",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-02",
        "status": "A",
        "authorized_official_last_name": "CORBALLY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CO OWNER",
        "authorized_official_telephone_number": "802-281-3330",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "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": [
        {
            "organization_name": "Center for Trauma Recovery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brian M Aucter, DPT
• Jillian Beayon
• Brian Aucter Physical Therapy PLC
• Elizabeth Cahill
• Cambridge Rescue Squad Inc.
• Gina M Ciancia, RN
• John M Dunn, MD
• Ellen Marie Duval, LICSW
• Robin Erickson, MS, LCMHC
• Eleanor Gagne

• Clinical Social Worker in Jeffersonville, VT
• Providers in Jeffersonville, 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 10, 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.