Provider Demographics
NPI:1780314211
Name:BOREAL PSYCHIATRY PLC
Entity type:Organization
Organization Name:BOREAL PSYCHIATRY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-636-4545
Mailing Address - Street 1:4185 ST GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7695
Mailing Address - Country:US
Mailing Address - Phone:802-636-4545
Mailing Address - Fax:
Practice Address - Street 1:4185 ST GEORGE RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7695
Practice Address - Country:US
Practice Address - Phone:802-636-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty