Healthcare Provider Details

I. General information

NPI: 1811268824
Provider Name (Legal Business Name): SHIRA R. LOURIA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE. UVM MEDICAL CENTER, DEPT. OF PSYCHIATRY
BURLINGTON VT
05401
US

IV. Provider business mailing address

111 COLCHESTER AVE. UVM MEDICAL CENTER, DEPT. OF PSYCHIATRY
BURLINGTON VT
05401
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3634
  • Fax: 802-847-8961
Mailing address:
  • Phone: 802-847-3634
  • Fax: 802-847-8961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number048.0083762
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: