| Doctor Name: | DR. MARK J DETZER |
| NPI Number: | 1215032214 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 854 |
| Business Practice Address: | 85 N Main St Suite 200 White River Junction, VT - 050017134 |
| Business Phone Number: | 8022996498 |
| Business Fax Number: | 8889721623 |
| Mailing Address: | Po Box 712, WHITE RIVER JUNCTION |
| State: | VT |
| Postal Code: | 050010712 |
| Phone Number: | 8022996498 |
| Fax Number: | 8889721623 |
| NPI Enumeration Date: | 09/14/2006 |
| NPI Last Update Date: | 10/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 854 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |