Healthcare Provider Details

I. General information

NPI: 1255361267
Provider Name (Legal Business Name): PATRICIA ANN MCCULLAGH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 BENMONT AVE STE C3-80H
BENNINGTON VT
05201-1945
US

IV. Provider business mailing address

160 BENMONT AVE STE C3-80H
BENNINGTON VT
05201-1945
US

V. Phone/Fax

Practice location:
  • Phone: 802-786-4900
  • Fax:
Mailing address:
  • Phone: 802-786-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number048-0000786
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: