Provider Demographics
NPI:1083757363
Name:VERMONT, NANCY (PSYD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:VERMONT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-0183
Mailing Address - Country:US
Mailing Address - Phone:631-288-3558
Mailing Address - Fax:631-288-9424
Practice Address - Street 1:12 OAK ST
Practice Address - Street 2:
Practice Address - City:WHB
Practice Address - State:NY
Practice Address - Zip Code:11978-0183
Practice Address - Country:US
Practice Address - Phone:631-288-3558
Practice Address - Fax:631-288-9424
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10631103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV6A491Medicare ID - Type Unspecified