Marilyn Jean Renaudette, M.A.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

047-0000736 Issued in VT

Practice address

4185 St George Rd
Williston, VT 05495-7695

Phone

(802) 651-7730

Fax

(802) 651-7730

NPI assigned

May 21, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Marilyn Jean Edwards Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222992000000",
    "number": "1003073644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 IAN PL",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054954408",
            "telephone_number": "802-764-1282",
            "fax_number": "802-764-1282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4185 ST GEORGE RD",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054957695",
            "telephone_number": "802-651-7730",
            "fax_number": "802-651-7730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENAUDETTE",
        "first_name": "MARILYN",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "M.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-21",
        "last_updated": "2008-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "VT",
            "license": "047-0000736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1015179",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARILYN",
            "last_name": "EDWARDS",
            "middle_name": "JEAN",
            "credential": "M.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Raya Noreault Lcmhc PLC
• Reach Hand Therapy PLLC
• Paul Reiss, MD
• Reliable Respiratory, Inc.
• Sean Billings Remillard
• Nancy Irene Resi, FNP
• Ashley Nicole Richardson
• Kathryn Rick, PH.D.
• Samantha Riden, LCMHC
• Warren Rinehart, M.D.

• Psychologist in Williston, VT
• Providers in Williston, VT by specialty
• Psychologist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.