Doctor Name: | DR. PAMELA JOAN KNEISEL |
NPI Number: | 1063549244 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | 587 |
Business Practice Address: | 53 S Main St Hanover, VT - 05075 |
Business Phone Number: | 6036435253 |
Business Fax Number: | |
Mailing Address: | 53 S. Main St., HANOVER |
State: | VT |
Postal Code: | 05075 |
Phone Number: | 6036435253 |
Fax Number: | |
NPI Enumeration Date: | 02/27/2007 |
NPI Last Update Date: | 02/23/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 587 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | VT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |