Provider Demographics
NPI:1659450070
Name:DEAN, CHERYL D (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:D
Last Name:DEAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 MERCHANTS ROW
Mailing Address - Street 2:SUITE 309
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-5909
Mailing Address - Country:US
Mailing Address - Phone:802-786-2442
Mailing Address - Fax:802-786-2299
Practice Address - Street 1:128 MERCHANTS ROW
Practice Address - Street 2:SUITE 309
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-5909
Practice Address - Country:US
Practice Address - Phone:802-786-2442
Practice Address - Fax:802-786-2299
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT567103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT18801OtherBLUECROSSBLUESHIELD
VT0VN1041Medicaid
VT0VN1041Medicaid