Twin State Psychological Services | |
29 Ridgewood Rd Springfield VT 05156-3060 | |
(802) 885-5719 | |
(802) 885-5720 |
Full Name | Twin State Psychological Services |
---|---|
Speciality | Psychologist |
Location | 29 Ridgewood Rd, Springfield, Vermont |
Authorized Official Name and Position | Richard W. Root (OWNER) |
Authorized Official Contact | 8028855719 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Twin State Psychological Services Po Box 2003 Springfield VT 05156-2003 Ph: (802) 885-5719 | Twin State Psychological Services 29 Ridgewood Rd Springfield VT 05156-3060 Ph: (802) 885-5719 |
NPI Number | 1356579775 |
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Provider Enumeration Date | 06/24/2009 |
Last Update Date | 09/13/2016 |
Medicare PECOS PAC ID | 2062676638 |
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Medicare Enrollment ID | O20120611000537 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356579775 | NPI | - | NPPES |
1016751 | Medicaid | VT | |
3080088 | Medicaid | NH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103T00000X | Psychologist | (* (Not Available)) | Primary |
Provider Name | Richard W Root |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1902823636 PECOS PAC ID: 3678742491 Enrollment ID: I20110817000011 |
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