Provider Demographics
NPI:1124676853
Name:GEARY, TOWANDA
Entity type:Individual
Prefix:
First Name:TOWANDA
Middle Name:
Last Name:GEARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAWSON LN STE 200C
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8445
Mailing Address - Country:US
Mailing Address - Phone:802-734-8753
Mailing Address - Fax:
Practice Address - Street 1:1 LAWSON LN STE 200C
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8445
Practice Address - Country:US
Practice Address - Phone:802-734-8753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0065974103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist