Healthcare Provider Details

I. General information

NPI: 1336059351
Provider Name (Legal Business Name): VERMONT RELATIONAL PSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 PINE HAVEN SHORES RD
SHELBURNE VT
05482-7703
US

IV. Provider business mailing address

145 PINE HAVEN SHORES RD STE 1000-888
SHELBURNE VT
05482-7703
US

V. Phone/Fax

Practice location:
  • Phone: 802-435-6180
  • Fax:
Mailing address:
  • Phone: 802-435-6180
  • 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. EMILY BLITZ
Title or Position: PRESIDENT
Credential: PSYD
Phone: 802-435-6180