| Doctor Name: | TAMARA M DERSIA |
| NPI Number: | 1255598355 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCMHC |
| License Number: | 0680000742 |
| Business Practice Address: | 49 Castleton Meadows Ln Castleton, VT - 057359011 |
| Business Phone Number: | 8025583477 |
| Business Fax Number: | |
| Mailing Address: | 20 Adams St, FAIR HAVEN |
| State: | VT |
| Postal Code: | 057431238 |
| Phone Number: | 8022653558 |
| Fax Number: | |
| NPI Enumeration Date: | 05/18/2008 |
| NPI Last Update Date: | 05/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 0680000742 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |