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General NPI Number Information
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NPI Number | 1538724562
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Entity Type | Individual
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Provider Name | MATTHEW ALBAUGH PHD
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Gender | Male
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 12/02/2019
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Provider Practice Location Address
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Address Line | 1 S PROSPECT ST
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City | BURLINGTON
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State | VT
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Zip | 05401-3456
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Country | US
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Telephone | 802-656-2175
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Fax |
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Provider Business Mailing Address
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Address Line | 59 NASHVILLE RD
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City | JERICHO
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State | VT
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Zip | 05465-9615
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Country | US
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Telephone |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 048.0134168
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License Number State | VT
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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 | 048.0134168
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License Number State | VT
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