Provider Demographics
NPI:1992916514
Name:OPPEDISANO, GERALDINE (PHD)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:OPPEDISANO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 BATTERY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5283
Mailing Address - Country:US
Mailing Address - Phone:802-660-2939
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 9278
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05407-9278
Practice Address - Country:US
Practice Address - Phone:802-660-2939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT855103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOPVN3939Medicaid
VT1011591Medicare ID - Type UnspecifiedVERMONT MEDICARE