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General NPI Number Information
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NPI Number | 1427053586
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Entity Type | Individual
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Provider Name | MILTON J MARASCH PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 148 COLLEGE ST STE 202A
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City | BURLINGTON
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State | VT
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Zip | 05401-8681
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Country | US
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Telephone | 802-985-9191
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Fax | 802-985-8181
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Provider Business Mailing Address
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Address Line | 145 PINE HAVEN SHORES RD STE 1011
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City | SHELBURNE
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State | VT
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Zip | 05482-7812
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Country | US
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Telephone | 802-985-9191
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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 | 717
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License Number State | VT
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