Provider Demographics
NPI:1619601994
Name:TOMASULO, GREGORY (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:TOMASULO
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 1:41 JUNIPER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-4397
Mailing Address - Country:US
Mailing Address - Phone:802-735-5231
Mailing Address - Fax:
Practice Address - Street 1:350 FISHER RD
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05633-7901
Practice Address - Country:US
Practice Address - Phone:802-828-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0106696103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical