Healthcare Provider Details

I. General information

NPI: 1033282447
Provider Name (Legal Business Name): JANE GARBOSE M.A., L.A.D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 MAIN ST
MIDDLEBURY VT
05753-1416
US

IV. Provider business mailing address

27 INN RD APT 1
CHARLOTTE VT
05445-8241
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-2224
  • Fax:
Mailing address:
  • Phone: 802-388-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number644
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number644
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: