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General NPI Number Information
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NPI Number | 1831151687
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Entity Type | Individual
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Provider Name | MARC A. CECIL PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 65 N MAIN ST
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City | RUTLAND
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State | VT
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Zip | 05701-3252
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Country | US
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Telephone | 802-773-3616
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Fax |
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Provider Business Mailing Address
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Address Line | 65 N MAIN ST
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City | RUTLAND
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State | VT
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Zip | 05701-3252
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Country | US
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Telephone | 802-773-3616
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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 | 048-0000414
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License Number State | VT
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