Provider Demographics
NPI:1427053586
Name:MARASCH, MILTON J (PHD)
Entity type:Individual
Prefix:DR
First Name:MILTON
Middle Name:J
Last Name:MARASCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 PINE HAVEN SHORES RD STE 1011
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7812
Mailing Address - Country:US
Mailing Address - Phone:802-985-9191
Mailing Address - Fax:
Practice Address - Street 1:148 COLLEGE ST STE 202A
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8681
Practice Address - Country:US
Practice Address - Phone:802-985-9191
Practice Address - Fax:802-985-8181
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT717103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT2033041OtherCIGNA
VT39072OtherBCBS
VT0VN2151Medicaid
VT324707OtherMVP
VTMAVN2151Medicare ID - Type Unspecified