Provider Demographics
NPI:1457413593
Name:RAMIREZ, ELENA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:MARIE
Last Name:RAMIREZ
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:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-0343
Mailing Address - Country:US
Mailing Address - Phone:802-651-8999
Mailing Address - Fax:802-651-8997
Practice Address - Street 1:595 DORSET ST
Practice Address - Street 2:STE 2
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6240
Practice Address - Country:US
Practice Address - Phone:802-651-8999
Practice Address - Fax:802-651-8997
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTVT728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT573107Medicare UPIN
VTRAVN1897Medicare ID - Type Unspecified
1006525Medicare ID - Type Unspecified