Healthcare Provider Details

I. General information

NPI: 1568646891
Provider Name (Legal Business Name): SUSAN MUIR TROMBLEY LIC. PSY. MA, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN CAROL MUIR LIC PSY. MA, LCMHC

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 FISHER POND RD
SAINT ALBANS VT
05478-6286
US

IV. Provider business mailing address

31 MONUMENT RD
SWANTON VT
05488-1056
US

V. Phone/Fax

Practice location:
  • Phone: 802-524-6555
  • Fax: 802-524-6562
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068-0000073
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number047-0000465
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: