Provider Demographics
NPI:1831271311
Name:NATH, PAULA (PSYCHOLOGIST)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:
Last Name:NATH
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:MS
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:NATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYCHOLOGIST
Mailing Address - Street 1:PO BOX 166
Mailing Address - Street 2:
Mailing Address - City:EAST MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05740-0166
Mailing Address - Country:US
Mailing Address - Phone:802-388-2035
Mailing Address - Fax:802-388-2035
Practice Address - Street 1:41 SCHOOLHOUSE HILL ROAD
Practice Address - Street 2:
Practice Address - City:EAST MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05740
Practice Address - Country:US
Practice Address - Phone:802-388-2035
Practice Address - Fax:802-388-2035
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000031103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2871Medicare ID - Type UnspecifiedPSYCHOLOGIST