Healthcare Provider Details

I. General information

NPI: 1427053586
Provider Name (Legal Business Name): MILTON J MARASCH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 COLLEGE ST STE 202A
BURLINGTON VT
05401-8681
US

IV. Provider business mailing address

145 PINE HAVEN SHORES RD STE 1011
SHELBURNE VT
05482-7812
US

V. Phone/Fax

Practice location:
  • Phone: 802-985-9191
  • Fax: 802-985-8181
Mailing address:
  • Phone: 802-985-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number717
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: