Healthcare Provider Details

I. General information

NPI: 1659387363
Provider Name (Legal Business Name): JUDITH RAE GERBER PHD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

33 SUMMIT RDG
BURLINGTON VT
05401-3911
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-1400
  • Fax:
Mailing address:
  • Phone: 902-862-6061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number048-0000762
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number048-0000762
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number048-0000762
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: