Individual
MS. M CORBIN GOULD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPMA
Contact information
Practice address
149 STATE STREET - THE REDFIELD HOUSE, MONTPELIER, VT 05602-0560
(802) 223-4111
Mailing address
149 STATE STREET, MONTPELIER, VT 05602
(802) 223-4111
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
047-0000702
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
062-58242
BC/BS #
VT
05
—
1008048
—
VT
05
—
470000702
—
VT
01
—
614320
MVP PROVIDER #
VT
01
—
776927000
MAGELLAN
VT
Enumeration date
10/27/2006
Last updated
08/06/2020
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