| NPI | 1952799694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MARY STEPHEN Psychologist 802-355-9299 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 048-0000778) |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2019-06-13 |