Healthcare Provider Details

I. General information

NPI: 1457766768
Provider Name (Legal Business Name): MADISON E SMITH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MILLET ST STE 203
RICHMOND VT
05477-9623
US

IV. Provider business mailing address

PO BOX 15
WESTFORD VT
05494-0015
US

V. Phone/Fax

Practice location:
  • Phone: 802-391-0096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number048.0134613
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: