Provider Demographics
NPI:1578292579
Name:NIITEPOLD, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:NIITEPOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#1013
Mailing Address - Street 2:768 PUTNEY ROAD UNIT 1
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301
Mailing Address - Country:US
Mailing Address - Phone:802-234-1024
Mailing Address - Fax:
Practice Address - Street 1:150 WEST ST
Practice Address - Street 2:
Practice Address - City:DUMMERSTON
Practice Address - State:VT
Practice Address - Zip Code:05301-9660
Practice Address - Country:US
Practice Address - Phone:802-234-1024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0135135103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist