Healthcare Provider Details

I. General information

NPI: 1043446487
Provider Name (Legal Business Name): GAIL LYNN ISENBERG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 SHELBURNE RD SUITE 120
SOUTH BURLINGTON VT
05403-7700
US

IV. Provider business mailing address

PO BOX 948
MIDDLEBURY VT
05753-0948
US

V. Phone/Fax

Practice location:
  • Phone: 802-236-1675
  • Fax:
Mailing address:
  • Phone: 802-236-1675
  • Fax: 802-462-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0480000629
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0480000629
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: