Healthcare Provider Details

I. General information

NPI: 1578577508
Provider Name (Legal Business Name): JAMES M TALLMADGE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST ARNOLD 3
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

19 BARBARA TER
COLCHESTER VT
05446-6623
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4560
  • Fax: 802-847-8747
Mailing address:
  • Phone: 802-658-6321
  • Fax: 888-908-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number048-0000475
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number048-0000475
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number048-0000475
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: