Organization Name: | PSYCHOTHERAPY ASSOCIATES |
NPI Number: | 1104034529 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ALBON J COGHLON (OWNER) |
Mailing Address: | 90 Mahoney Ave Rutland |
State: | VT US |
Postal Code: | 05701 |
Phone Number: | 8027752581 |
Fax Number: | 8027753395 |
NPI Enumeration Date: | 05/18/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 0680000177 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | VT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |