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General NPI Number Information
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NPI Number | 1326401670
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Entity Type | Organization
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Legal Business Name | SYNCHROSAIC LLC
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 183 TALCOTT RD
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City | WILLISTON
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State | VT
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Zip | 05495-2089
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Country | US
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Telephone | 802-922-1612
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 345
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City | RICHMOND
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State | VT
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Zip | 05477-0345
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Country | US
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Telephone | 802-922-1612
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | CATHERINE E BURNS
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Credential | PHD
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Telephone | 802-922-1612
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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 | 048.0000857
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License Number State | VT
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