Provider Demographics
NPI:1578731279
Name:MEYER, AUGUST R (PHD)
Entity Type:Individual
Prefix:DR
First Name:AUGUST
Middle Name:R
Last Name:MEYER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-1017
Mailing Address - Country:US
Mailing Address - Phone:802-728-3637
Mailing Address - Fax:
Practice Address - Street 1:8 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1017
Practice Address - Country:US
Practice Address - Phone:802-728-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000205103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical