Healthcare Provider Details

I. General information

NPI: 1891370334
Provider Name (Legal Business Name): ONION RIVER PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 MAIN ST
MONTPELIER VT
05602-3226
US

IV. Provider business mailing address

9 DERBY DR
MONTPELIER VT
05602-3312
US

V. Phone/Fax

Practice location:
  • Phone: 802-277-7979
  • Fax:
Mailing address:
  • Phone: 802-299-5125
  • Fax: 620-202-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIANA A TEXTER
Title or Position: BILLING MANAGER
Credential:
Phone: 321-663-9590