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General NPI Number Information
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NPI Number | 1710099791
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Entity Type | Individual
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Provider Name | BETH ANNE WERMUTH MA
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 145 PINE HAVEN SHORES RD SUITE 2032
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City | SHELBURNE
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State | VT
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Zip | 05482-7703
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Country | US
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Telephone | 802-864-4513
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Fax |
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Provider Business Mailing Address
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Address Line | 417 PETTINGILL RD
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City | ESSEX JUNCTION
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State | VT
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Zip | 05452-2669
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Country | US
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Telephone | 802-864-4513
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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 | 047-0000639
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License Number State | VT
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