| Full Cup Llc | |
|
33 College St Montpelier VT 05602-3674 | |
| (802) 379-9079 | |
| Not Available |
| Full Name | Full Cup Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 33 College St, Montpelier, Vermont |
| Authorized Official Name and Position | Tomasen W Weinbaum (SOLE MEMBER) |
| Authorized Official Contact | 8029171970 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Full Cup Llc 33 College St Montpelier VT 05602-3674 Ph: (802) 379-9079 | Full Cup Llc 33 College St Montpelier VT 05602-3674 Ph: (802) 379-9079 |
| NPI Number | 1396541827 |
|---|---|
| Provider Enumeration Date | 02/24/2025 |
| Last Update Date | 02/24/2025 |
| Certification Date | 02/20/2025 |
| Medicare PECOS PAC ID | 7810418753 |
|---|---|
| Medicare Enrollment ID | O20250307000216 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396541827 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Tomasen Woodworth Weinbaum |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881474799 PECOS PAC ID: 8729509666 Enrollment ID: I20250307000267 |
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