Healthcare Provider Details

I. General information

NPI: 1679652002
Provider Name (Legal Business Name): MATTHEW STONE ZILBOORG MACP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 PATCHEN RD
SOUTH BURLINGTON VT
05403-5704
US

IV. Provider business mailing address

34 PATCHEN RD
SOUTH BURLINGTON VT
05403-5704
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-4208
  • Fax: 802-658-2234
Mailing address:
  • Phone: 802-658-4208
  • Fax: 802-658-2234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number047-0000317
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: