Individual
MS. SUSAN AUGUSTE ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPMA
Contact information
Practice address
53 HEMLOCK ROAD, EAST CALAIS, VT 05650
(802) 456-1600
Mailing address
27 HEMLOCK RD, EAST CALAIS, VT 05650-8169
(802) 456-1600
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
047-0000515
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003431
—
VT
Enumeration date
04/02/2007
Last updated
07/08/2007
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