Crystal Irish, LADAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

151.0134105 Issued in VT

Practice address

39 Fogg Farm Rd
White River JCT, VT 05088-0508

Phone

(802) 295-1311

NPI assigned

Jan 21, 2021

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Clara Martin Center

  • Community/Behavioral Health Agency
  • Randolph, VT
  • NPI 1386710861

  VT

  Medicare reassignment Care Compare group NPD
• Clara Martin Center

  • Community/Behavioral Health Agency
  • Randolph, VT
  • NPI 1548060015
  NPD

Specialty

Mental Health Counselor

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Clara Martin Center 17 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in VT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 21, 2021.

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1972193266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX G",
            "city": "RANDOLPH",
            "state": "VT",
            "postal_code": "050600167",
            "telephone_number": "802-728-4466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 FOGG FARM RD",
            "city": "WHITE RIVER JCT",
            "state": "VT",
            "postal_code": "050880508",
            "telephone_number": "802-295-1311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRISH",
        "first_name": "CRYSTAL",
        "credential": "LADAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-21",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "VT",
            "license": "151.0134105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Grace Brennan, LMFT
• Brookside Nursing Home Inc
• Lloyd Robert Bunten, RPH
• Caroline Margaret Craig, MSPT
• Laura Decapua, BA
• Erika Skyler Kardatzke, MA BCBA
• Robert Brooks Robey, MD
• Robert Thomas Sennett, RRT
• Gikanh Timberwolf, MA
• Town of Hartford School District

• All providers in White River JCT, VT
• Addiction (Substance Use Disorder) Counselor in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.