Individual
JEREMY DIXON BIRCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
73 MAIN ST, BRATTLEBORO, VT 05301-3909
(802) 257-9468
Mailing address
136 BIRCH LN, PUTNEY, VT 05346-9392
(802) 257-9468
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
048-0000049
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006514
—
VT
Enumeration date
11/13/2006
Last updated
07/08/2007
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