Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 097.0085317 | VT |
NPI | 1013575372 |
---|---|
Provider Name | Roberta M. White |
First Address | Brattleboro, VT 05301 |
Second Address | Brattleboro, VT 05301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2019 |
Last Update Date | 03/06/2019 |