Provider Demographics
NPI:1194897546
Name:DEERING, GAIA ANNE (PSYCHOLOGIST-MASTER)
Entity type:Individual
Prefix:
First Name:GAIA
Middle Name:ANNE
Last Name:DEERING
Suffix:
Gender:F
Credentials:PSYCHOLOGIST-MASTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504A MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2111
Mailing Address - Country:US
Mailing Address - Phone:802-681-7314
Mailing Address - Fax:
Practice Address - Street 1:504A MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2111
Practice Address - Country:US
Practice Address - Phone:802-681-7314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4539101YM0800X
VT047-0000631103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA31738OtherHEALTH NEW ENGLAND