NPI | 1497809867 |
---|---|
Entity Type | Organization |
Authorized Contact | RAVEN BRUCE President 802-793-9316 |
Organization Subpart ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 048-0000694) |
Enumeration Date | 2007-01-23 |
Last Update Date | 2020-08-22 |