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General NPI Number Information
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NPI Number | 1063549244
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Entity Type | Individual
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Provider Name | PAMELA JOAN KNEISEL PHD
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Gender | Female
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 53 S MAIN ST
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City | HANOVER
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State | VT
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Zip | 05075
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Country | US
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Telephone | 603-643-5253
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Fax |
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Provider Business Mailing Address
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Address Line | 53 S. MAIN ST.
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City | HANOVER
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State | VT
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Zip | 05075
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Country | US
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Telephone | 603-643-5253
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 388
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 587
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License Number State | VT
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