Provider Demographics
NPI:1538719232
Name:PSYCHOTHERAPY VERMONT, PLC
Entity type:Organization
Organization Name:PSYCHOTHERAPY VERMONT, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:PICHLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-593-0085
Mailing Address - Street 1:76 W ALLEN ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-2197
Mailing Address - Country:US
Mailing Address - Phone:510-593-0085
Mailing Address - Fax:
Practice Address - Street 1:269 PEARL ST STE 1
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8536
Practice Address - Country:US
Practice Address - Phone:510-593-0085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health