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General NPI Number Information
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NPI Number | 1982311882
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Entity Type | Organization
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Legal Business Name | PSYIPSUM LLC
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 278 COLLEGE ST
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City | BURLINGTON
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State | VT
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Zip | 05401-8319
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Country | US
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Telephone | 802-497-2187
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Fax |
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Provider Business Mailing Address
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Address Line | 278 COLLEGE ST
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City | BURLINGTON
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State | VT
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Zip | 05401-8319
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Country | US
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Telephone | 802-497-2187
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL O'TOOLE
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Credential |
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Telephone | 802-497-2187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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