Organization
STATE OF VERMONT
Active
Other names
Vermont State Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERRY ROWE (EXECUTIVE DIRECTOR)
(802) 241-3100
Entity
Organization
Contact information
Practice address
103 SOUTH MAIN STREET, WATERBURY, VT 05671-9800
(802) 241-3009
(802) 241-1439
Mailing address
103 SOUTH MAIN STREET, WATERBURY, VT 05671-9800
(802) 241-3009
(802) 241-1439
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
474002
—
VT
05
—
474003
—
VT
05
—
VT4000
—
VT
Enumeration date
10/17/2006
Last updated
04/23/2008
Update your record
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