Provider Demographics
NPI:1700851722
Name:MELLINGER, DAVID (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:MELLINGER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-1813
Mailing Address - Country:US
Mailing Address - Phone:802-447-1231
Mailing Address - Fax:802-442-1203
Practice Address - Street 1:185 NORTH ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1813
Practice Address - Country:US
Practice Address - Phone:802-447-1231
Practice Address - Fax:802-442-1203
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000472103TA0700X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT41025OtherMVP HEALTH CARE
VT5790OtherVT BLUE CROSS/BLUE SHIELD
VT0009742Medicaid
VT0009742Medicaid