Provider Demographics
NPI:1346072956
Name:ANISE PSYCHOLOGICAL SERVICES VERMONT PLLC
Entity type:Organization
Organization Name:ANISE PSYCHOLOGICAL SERVICES VERMONT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOURIA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:802-552-0619
Mailing Address - Street 1:250 MAIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-4257
Mailing Address - Country:US
Mailing Address - Phone:802-552-0619
Mailing Address - Fax:
Practice Address - Street 1:250 MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-4257
Practice Address - Country:US
Practice Address - Phone:802-552-0619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty