Provider Demographics
NPI:1679864847
Name:SONG, PATRICIA HIMI (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:HIMI
Last Name:SONG
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 1:1 HOPKINS ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-2137
Mailing Address - Country:US
Mailing Address - Phone:802-839-6383
Mailing Address - Fax:
Practice Address - Street 1:79 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3173
Practice Address - Country:US
Practice Address - Phone:802-321-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0066873103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical