Healthcare Provider Details

I. General information

NPI: 1952338097
Provider Name (Legal Business Name): THOMAS HERSH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 RADWAY HILL RD.
NEWFANE VT
05345
US

IV. Provider business mailing address

PO BOX 370
NEWFANE VT
05345-0370
US

V. Phone/Fax

Practice location:
  • Phone: 802-365-9245
  • Fax: 802-365-9333
Mailing address:
  • Phone: 802-365-9245
  • Fax: 802-365-9333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberVT642
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: