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27 Rye Circle South Burlington VT 05483 | |
| (802) 777-8703 | |
| (802) 654-9155 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 27 Rye Circle, South Burlington, Vermont |
| Authorized Official Name and Position | Elizabeth Ann Jensen (PRESIDENT) |
| Authorized Official Contact | 8027778703 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 666 Shelburne VT 05482-0666 Ph: (802) 777-8703 | 27 Rye Circle South Burlington VT 05483 Ph: (802) 777-8703 |
| NPI Number | 1710332549 |
|---|---|
| Provider Enumeration Date | 04/29/2016 |
| Last Update Date | 04/29/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710332549 | NPI | - | NPPES |
| 1740440122 | Other | PROVIDER NPI | |
| 1025437 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 042.0013202 (Vermont) | Primary |
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