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General NPI Number Information
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NPI Number | 1215092242
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Entity Type | Individual
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Provider Name | AMY MAXINE TREE MACP
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Gender | Female
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 01/31/2009
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Provider Practice Location Address
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Address Line | 3 MAIN ST SUITE 216
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City | BURLINGTON
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State | VT
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Zip | 05401-5216
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Country | US
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Telephone | 802-651-7517
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Fax | 802-860-1234
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Provider Business Mailing Address
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Address Line | 3 MAIN ST SUITE 216
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City | BURLINGTON
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State | VT
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Zip | 05401-5216
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Country | US
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Telephone | 802-651-7517
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Fax | 802-860-1234
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0470000679
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License Number State | VT
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