Healthcare Provider Details

I. General information

NPI: 1972359834
Provider Name (Legal Business Name): ERIC QUINTIN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HEATON ST
MONTPELIER VT
05602-2489
US

IV. Provider business mailing address

PO BOX 647
MONTPELIER VT
05601-0647
US

V. Phone/Fax

Practice location:
  • Phone: 802-223-6328
  • Fax: 802-229-8004
Mailing address:
  • Phone: 802-223-6328
  • Fax: 802-229-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number048.0135061
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: