Provider Demographics
NPI:1629289426
Name:MARGOLIS, GARY FRANCIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:FRANCIS
Last Name:MARGOLIS
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 1:639 SPERRY RD
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:VT
Mailing Address - Zip Code:05753-9450
Mailing Address - Country:US
Mailing Address - Phone:802-462-2129
Mailing Address - Fax:802-433-3407
Practice Address - Street 1:302 CENTENO HOUSE ROUTE 30
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753
Practice Address - Country:US
Practice Address - Phone:802-443-5141
Practice Address - Fax:802-443-3407
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0480000114103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist