Healthcare Provider Details

I. General information

NPI: 1780941260
Provider Name (Legal Business Name): METTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 OLD DEPOT RD
ARLINGTON VT
05250-8748
US

IV. Provider business mailing address

PO BOX 888
MANCHESTER VT
05254-0888
US

V. Phone/Fax

Practice location:
  • Phone: 413-822-3661
  • Fax:
Mailing address:
  • Phone: 413-822-3661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number048.0000526
License Number StateVT

VIII. Authorized Official

Name: DR. FRANCIS X MORIARTY
Title or Position: PSYCHOLOGIST
Credential: ED.D.
Phone: 413-822-3661