Provider Demographics
NPI:1245450568
Name:ADAIR, MARK J (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:ADAIR
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 1:259 NORTON RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05682-9792
Mailing Address - Country:US
Mailing Address - Phone:802-223-2641
Mailing Address - Fax:802-229-6348
Practice Address - Street 1:166 C ELM ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602
Practice Address - Country:US
Practice Address - Phone:802-223-3958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0480000172103TC0700X
NY0049131103TC0700X
VT102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst