Healthcare Provider Details

I. General information

NPI: 1972654978
Provider Name (Legal Business Name): NORI H BOKUM M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N MAIN ST SUITE 30
WHITE RIVER JUNCTION VT
05001-6200
US

IV. Provider business mailing address

PO BOX 108
NORWICH VT
05055-0108
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-7500
  • Fax:
Mailing address:
  • Phone: 802-295-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number634
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number634
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number634
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number634
License Number StateVT
# 5
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number634
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: