Individual
DR. MARY WILLMUTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
86 LAKE ST, BURLINGTON, VT 05401-5297
(802) 865-3450
Mailing address
86 LAKE ST, BURLINGTON, VT 05401-5297
(802) 865-3450
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009087
—
VT
Enumeration date
09/03/2006
Last updated
07/08/2007
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