| State Street Tms | |
|
147 State St Montpelier VT 05602-3301 | |
| (646) 361-2659 | |
| Not Available |
| Full Name | State Street Tms |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 147 State St, Montpelier, Vermont |
| Authorized Official Name and Position | Jada Marie Turco Khosla (MANAGER) |
| Authorized Official Contact | 6463612659 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| State Street Tms 147 State St Montpelier VT 05602-3301 Ph: (802) 321-3692 | State Street Tms 147 State St Montpelier VT 05602-3301 Ph: (646) 361-2659 |
| NPI Number | 1588347421 |
|---|---|
| Provider Enumeration Date | 08/08/2023 |
| Last Update Date | 09/19/2023 |
| Certification Date | 09/19/2023 |
| Medicare PECOS PAC ID | 0446609564 |
|---|---|
| Medicare Enrollment ID | O20231213003921 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588347421 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Jada Khosla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457474272 PECOS PAC ID: 0648589192 Enrollment ID: I20231213003949 |
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