Provider Demographics
NPI:1609997444
Name:HALL, LARRY (MA)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 STEELE ST
Mailing Address - Street 2:#113
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-6204
Mailing Address - Country:US
Mailing Address - Phone:802-862-2383
Mailing Address - Fax:802-862-2383
Practice Address - Street 1:1 STEELE ST
Practice Address - Street 2:#113
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-6204
Practice Address - Country:US
Practice Address - Phone:802-862-2383
Practice Address - Fax:802-862-2383
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000503103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1003291Medicaid
VT18337Medicare UPIN
VTHAVN2758Medicare ID - Type Unspecified
VT1003291Medicaid
VT347402Medicare UPIN
VT2015987Medicare UPIN