MEDICARE: DR. KATE JESSAMYN LONGMAID PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	048-0000630	VT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	VN1205	OTHER	VT	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609848324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATE JESSAMYN LONGMAID PH.D.

Provider Business Mailing Address
First Line	:	110 MAIN ST
Second Line	:	4TH FLOOR, SUITE 4B
City	:	BURLINGTON
State	:	VT
Zip	:	05401-8451
Country	:	US
Telephone Number	:	802-651-7535
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 MAIN ST
Second Line	:	4TH FLOOR, SUITE 4B
City	:	BURLINGTON
State	:	VT
Zip	:	05401-8451
Country	:	US
Telephone Number	:	802-651-7535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	10/11/2013

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