Individual
META ELIZA SURJAPUTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
111 COLCHESTER AVE, BURLINGTON, VT 05401-1473
(802) 847-3634
(802) 847-8961
Mailing address
111 COLCHESTER AVE, BURLINGTON, VT 05401-1473
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
048.0135289
VT
Other
Enumeration date
06/10/2021
Last updated
10/16/2025
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