Provider Demographics
NPI:1194719229
Name:KYLE, THOMAS GEORGE (MA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GEORGE
Last Name:KYLE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3173
Mailing Address - Country:US
Mailing Address - Phone:802-223-0162
Mailing Address - Fax:802-479-9050
Practice Address - Street 1:79 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3173
Practice Address - Country:US
Practice Address - Phone:802-223-0162
Practice Address - Fax:802-229-0594
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT47-000553103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical