Individual
MARK ANAGNOSTOPULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
ANNA MARSH LANE, BRATTLEBORO, VT 05302
(802) 257-7785
Mailing address
ANNA MARSH LANE, BRATTLEBORO, VT 05302
(802) 257-7785
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
048-0000319
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
048-0000319
LICENSE
VT
Enumeration date
05/10/2007
Last updated
03/31/2015
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