Individual
ELIZAVETA MATIACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPM
Contact information
Practice address
607 WASHINGTON HWY, MORRISVILLE, VT 05661-8652
(802) 888-8320
(802) 888-8136
Mailing address
PO BOX 749, MORRISVILLE, VT 05661-0749
(802) 851-8619
(802) 851-8716
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
151.0127410
VT
103T00000X
Psychologist
047-0000698
VT
103TC0700X
Clinical Psychologist
Primary
047.0000698
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00058059
BCBS
VT
05
—
1007708
—
VT
01
—
2081698
CIGNA
VT
01
—
615535
MVP
VT
Enumeration date
10/13/2006
Last updated
01/22/2024
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