Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 048-0000522 | VT |
NPI | 1114983939 |
---|---|
Provider Name | Dr. Clifford Miles Karmiohl |
First Address | South Burlington, VT 05403-5704 |
Second Address | South Burlington, VT 05403-5704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 11/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003397 | (05) | VT |
18106 | BC & BS OF VERMONT (01) | VT |