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General NPI Number Information
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NPI Number | 1538768304
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Entity Type | Organization
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Legal Business Name | LUX TELEPSYCH PLC
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 4185 ST GEORGE RD
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City | WILLISTON
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State | VT
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Zip | 05495-7695
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Country | US
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Telephone | 802-266-4465
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Fax | 802-531-3226
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Provider Business Mailing Address
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Address Line | 4185 ST GEORGE RD
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City | WILLISTON
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State | VT
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Zip | 05495-7695
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Country | US
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Telephone | 802-266-4465
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Fax | 802-531-3226
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Authorized Official
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Title or Position | SOLE OWNER
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Name | JESSICA JAWIDZIK
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Credential | DNP
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Telephone | 802-266-4465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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