Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 071-007011 | IL |
N | 103TC0700X | Clinical Psychologist | 071-007011 | IL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 7805018-2501 | UT |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 80416 | VT |
NPI | 1043371891 |
---|---|
Provider Name | Courtney Landau Fleisher |
First Address | Burlington, VT 05401-1473 |
Second Address | Burlington, VT 05401-1473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 06/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1019704 | (05) | VT |
34200275 | (05) | NH |