Healthcare Provider Details

I. General information

NPI: 1629185731
Provider Name (Legal Business Name): MARILYN L TURCOTTE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MONSIGNOR CROSBY AVE
MONTPELIER VT
05602-3517
US

IV. Provider business mailing address

16 MONSIGNOR CROSBY AVE
MONTPELIER VT
05602-3517
US

V. Phone/Fax

Practice location:
  • Phone: 802-229-0203
  • Fax: 802-229-0011
Mailing address:
  • Phone: 802-229-0203
  • Fax: 802-229-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number048.0063811
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3658-125
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number068-0000212
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: