Individual
ETHAN KEYES VANDERMARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
113 MARKET ST, APT. 2, NORTHAMPTON, MA 01060-3211
(603) 502-3714
Mailing address
113 MARKET ST, APT. 2, NORTHAMPTON, MA 01060-3211
(603) 502-3714
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/24/2014
Last updated
10/17/2014
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