Individual
TAMARA M DEROSIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHC
Contact information
Practice address
912 ROUTE 4A W STE 2, HYDEVILLE, VT 05750-9700
(802) 558-3477
Mailing address
20 ADAMS ST, FAIR HAVEN, VT 05743-1238
(802) 265-3558
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0680000742
VT
Other
Enumeration date
05/18/2008
Last updated
09/23/2020
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