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General NPI Number Information
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NPI Number | 1588941090
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Entity Type | Individual
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Provider Name | WILLIAM PIATT KETTERER PSYD
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Gender | Male
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Dates
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Enumeration Date | 11/11/2011
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 85 N MAIN ST SUITE 210
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City | WHITE RIVER JUNCTION
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State | VT
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Zip | 05001-7134
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Country | US
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Telephone | 603-667-0533
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Fax | 888-972-4613
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Provider Business Mailing Address
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Address Line | PO BOX 28
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City | LYME
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State | NH
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Zip | 03768-0028
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Country | US
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Telephone | 603-667-0533
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Fax | 888-972-4613
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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 | 0480094410
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License Number State | VT
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