Provider Demographics
NPI:1578144549
Name:CONTRADA, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CONTRADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 BLISS RD
Mailing Address - Street 2:
Mailing Address - City:EAST MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05651-4168
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 E STATE ST STE 104
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3112
Practice Address - Country:US
Practice Address - Phone:802-595-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047.0133689103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist