Healthcare Provider Details

I. General information

NPI: 1942303938
Provider Name (Legal Business Name): ELEANOR J ANDERSON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 MAIN STREET THE BURTON HOUSE
NORWICH VT
05055
US

IV. Provider business mailing address

PO BOX 297
NORWICH VT
05055-0297
US

V. Phone/Fax

Practice location:
  • Phone: 802-649-2877
  • Fax:
Mailing address:
  • Phone: 802-649-2877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0470000548
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: