Healthcare Provider Details

I. General information

NPI: 1649109745
Provider Name (Legal Business Name): RIVERSIDE PSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
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 Number
License Number State

VIII. Authorized Official

Name: DR. MADISON ERIN SMITH
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 603-440-9395