| Maple Leaf Clinic Pc | |
|
167 N Main St Wallingford VT 05773-9800 | |
| (802) 446-3577 | |
| (802) 446-3801 |
| Full Name | Maple Leaf Clinic Pc |
|---|---|
| Speciality | Psychologist |
| Location | 167 N Main St, Wallingford, Vermont |
| Authorized Official Name and Position | Dean J Mooney (OWNER) |
| Authorized Official Contact | 8024463577 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maple Leaf Clinic Pc 167 N Main St Wallingford VT 05773-9800 Ph: (802) 446-3577 | Maple Leaf Clinic Pc 167 N Main St Wallingford VT 05773-9800 Ph: (802) 446-3577 |
| NPI Number | 1851715635 |
|---|---|
| Provider Enumeration Date | 02/13/2014 |
| Last Update Date | 02/05/2021 |
| Certification Date | 02/05/2021 |
| Medicare PECOS PAC ID | 8426463951 |
|---|---|
| Medicare Enrollment ID | O20210216001561 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851715635 | NPI | - | NPPES |
| 1022361 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 620 (Vermont) | Primary |
| Provider Name | Dean Jm Mooney |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568686822 PECOS PAC ID: 0446524011 Enrollment ID: I20170920001541 |
| Provider Name | Kayja Marie Champine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669136420 PECOS PAC ID: 1951780402 Enrollment ID: I20220614001295 |
| Provider Name | Lynn Dorsky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578242376 PECOS PAC ID: 3678937778 Enrollment ID: I20230907002947 |
| Provider Name | Jonathan P. Gilmore |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1760121867 PECOS PAC ID: 6406201243 Enrollment ID: I20231013000784 |
Recovery House, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 98 Church St, Wallingford, VT 05773 Phone: 802-446-2640 Fax: 802-446-2636 |