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NPI Code Detail

MEDICARE: DOUGLAS CLARK COREY M .A.

MEDICARE:   DOUGLAS CLARK COREY  M .A.
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
1103T00000XPsychologist0470000685VT

General Provider Information

NPI Number : 1629119094
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS CLARK COREY M .A.
Provider Business Mailing Address
First Line : 353 MAPLE ST
Second Line :
City : SALISBURY
State : VT
Zip : 05769-9428
Country : US
Telephone Number : 802-352-6689
Fax Number :
Provider Business Practice Location Address
First Line : 353 MAPLE ST
Second Line :
City : SALISBURY
State : VT
Zip : 05769-9428
Country : US
Telephone Number : 802-352-6689
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2007
Last Update Date : 07/08/2007

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Directions to “ DOUGLAS CLARK COREY M .A.” Practice Location

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