Healthcare Provider Details

I. General information

NPI: 1417025693
Provider Name (Legal Business Name): EDMUND P PIPER PSY.D.,LCMHC, LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 SCHOOL STREET
HARTFORD VT
05047
US

IV. Provider business mailing address

113 PATTRELL RD
NORWICH VT
05055-9611
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-3031
  • Fax: 802-295-0820
Mailing address:
  • Phone: 802-649-5241
  • Fax: 802-649-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0680000406
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000191
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: