Individual
JACOB ROBERT RUSCZEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
301 RIVER ST STE 204, MONTPELIER, VT 05602-4303
(802) 552-0548
Mailing address
8 WILDER ST APT 5, MONTPELIER, VT 05602-3818
(802) 505-5026
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
048.0121887
VT
Other
Enumeration date
07/17/2017
Last updated
07/17/2017
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