Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 042-0011143 | VT |
NPI | 1043263809 |
---|---|
Provider Name | Mario Hasaj |
First Address | Townshend, VT 05353-0216 |
Second Address | Townshend, VT 05353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 06/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G98525 | (02) |