Provider Demographics
NPI:1952441479
Name:BELCHER, DONNA SUSAN
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:SUSAN
Last Name:BELCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452
Mailing Address - Country:US
Mailing Address - Phone:802-879-1207
Mailing Address - Fax:802-388-4109
Practice Address - Street 1:50 COURT ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753
Practice Address - Country:US
Practice Address - Phone:802-388-3362
Practice Address - Fax:802-388-4109
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0470000454103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
079204OtherVALUE OPTIONS
VT6368OtherBLUE CROSS BLUE SHIELD
VT1003759Medicaid