=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740947654
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID TOMASI DSC HC, PHD, EDD-PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2021
-----------------------------------------------------
Last Update Date | 11/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 LAWSON LN STE 200G
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05401-8445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-489-6022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 STONE DR
-----------------------------------------------------
City | COLCHESTER
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05446-5744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-659-0310
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 048.0134190
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------