Healthcare Provider Details

I. General information

NPI: 1851501530
Provider Name (Legal Business Name): WELLSPRING MULTIDISCIPLINARY HEALTH AND EDUCATION PROJECT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CHURCH ST.
HARDWICK VT
05843-0147
US

IV. Provider business mailing address

PO BOX 147 39 CHURCH ST
HARDWICK VT
05843-0147
US

V. Phone/Fax

Practice location:
  • Phone: 802-472-6694
  • Fax: 802-472-6694
Mailing address:
  • Phone: 802-472-6694
  • Fax: 802-472-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberVT 509
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberVT 509
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberVT 509
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberVT 509
License Number StateVT
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberVT 509
License Number StateVT
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberVT 509
License Number StateVT
# 7
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberVT 509
License Number StateVT
# 8
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberVT 509
License Number StateVT
# 9
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberVT 509
License Number StateVT
# 10
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberVT 509
License Number StateVT
# 11
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberVT 509
License Number StateVT

VIII. Authorized Official

Name: MARGARET A. MCGUIRE
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 802-472-6694