Individual
MRS. SUSIE ELIZABETH CARON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
325 SWAMP RD, FAIRFAX, VT 05454-9777
(802) 849-2777
Mailing address
PO BOX 275, FAIRFAX, VT 05454-0275
(802) 849-2777
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
047-0000717
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011337
—
VT
Enumeration date
12/14/2006
Last updated
08/27/2008
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