| Vermont State Hospital | |
|
103 South Main Street Waterbury VT 05671-9800 | |
| (802) 241-3009 | |
| (802) 241-1439 |
| Full Name | Vermont State Hospital |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 103 South Main Street, Waterbury, Vermont |
| Authorized Official Name and Position | Terry Rowe (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8022413100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vermont State Hospital 103 South Main Street Waterbury VT 05671-9800 Ph: (802) 241-3009 | Vermont State Hospital 103 South Main Street Waterbury VT 05671-9800 Ph: (802) 241-3009 |
| NPI Number | 1215017678 |
|---|---|
| Provider Enumeration Date | 10/17/2006 |
| Last Update Date | 04/23/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215017678 | NPI | - | NPPES |
| VT4000 | Medicaid | VT | |
| 474003 | Medicaid | VT | |
| 474002 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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