Healthcare Provider Details

I. General information

NPI: 1962679282
Provider Name (Legal Business Name): MARIA EASTER COTTINGHAM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 LAKE ST
BURLINGTON VT
05401-5284
US

IV. Provider business mailing address

112 LAKE ST
BURLINGTON VT
05401-5284
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-8201
  • Fax:
Mailing address:
  • Phone: 802-864-8201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number048.0135220
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY23236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: