Healthcare Provider Details

I. General information

NPI: 1962199638
Provider Name (Legal Business Name): MARC A. CECIL, PH.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N MAIN ST
RUTLAND VT
05701-3252
US

IV. Provider business mailing address

65 N MAIN ST
RUTLAND VT
05701-3252
US

V. Phone/Fax

Practice location:
  • Phone: 802-773-3616
  • Fax:
Mailing address:
  • Phone: 802-773-3616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARC A CECIL A CECIL
Title or Position: PRESIDENT AND OWNER
Credential: PH.D.
Phone: 802-773-3616