Provider Demographics
NPI:1083867287
Name:PAUL FOXMAN, PH.D., INC.
Entity Type:Organization
Organization Name:PAUL FOXMAN, PH.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOXMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:802-865-3450
Mailing Address - Street 1:86 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5284
Mailing Address - Country:US
Mailing Address - Phone:802-865-3450
Mailing Address - Fax:802-859-3309
Practice Address - Street 1:112 LAKE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5284
Practice Address - Country:US
Practice Address - Phone:802-865-3450
Practice Address - Fax:802-859-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0480000185103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006558Medicaid