Organization
MAPLE LEAF CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEAN J MOONEY (OWNER)
(802) 446-3577
Entity
Organization
Contact information
Practice address
167 N MAIN ST, WALLINGFORD, VT 05773-9800
(802) 446-3577
(802) 446-3801
Mailing address
167 N MAIN ST, WALLINGFORD, VT 05773-9800
(802) 446-3577
(802) 446-3801
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
620
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022361
—
VT
Enumeration date
02/13/2014
Last updated
02/05/2021
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