Healthcare Provider Details

I. General information

NPI: 1194719229
Provider Name (Legal Business Name): THOMAS GEORGE KYLE MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MAIN ST
MONTPELIER VT
05602-3173
US

IV. Provider business mailing address

79 MAIN ST
MONTPELIER VT
05602-3173
US

V. Phone/Fax

Practice location:
  • Phone: 802-223-0162
  • Fax: 802-229-0594
Mailing address:
  • Phone: 802-223-0162
  • Fax: 802-479-9050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number47-000553
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: