Individual
JENNIFER ROMANS BURGOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD,
Contact information
Practice address
160 HOSPITAL DR, BENNINGTON, VT 05201-2279
(210) 615-3483
Mailing address
PO BOX 4412, BENNINGTON, VT 05201-4412
(802) 430-8355
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
048.0132428
VT
103TC0700X
Clinical Psychologist
PSY28112
CA
106H00000X
Marriage & Family Therapist
51200
CA
Other
Enumeration date
04/06/2007
Last updated
09/28/2021
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