Lynn M.H. Wickberg, MD
Individual provider Active NPI Child & Adolescent Psychiatry Physician · Springfield, VT
NPI 1013014059 · NPPES record last updated Nov 2, 2010
Key facts
- NPI
- 1013014059
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Child & Adolescent Psychiatry Physician 2084P0804X
- License
- 042-0009565 (VT)
- Practice address
- 390 River St.
Springfield, VT 05156-2226 - Phone
- (802) 886-4500
- Fax
- (282) 886-4520
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042-0009565 | VT | MD | Child & Adolescent Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Monadnock Family Services | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 11404 | NH | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 042-0009565 | VT | Yes |
Addresses
Primary practice location
390 River St.
Springfield, VT 05156-2226
Mailing address
390 River St.
Springfield, VT 05156-2226
Phone (802) 886-4500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1007840 | Medicaid | VT | |
| 81263595 | Medicaid | NH |
Other providers in Springfield, VT
- Heidi Weiss
- Anne M White
- Jessica Anne White
- Kathleen E White
- Simon White
- Knox Wilder
- Brooke Willard
- Cora Willis-Cooper
- Sarah S. Wimbiscus
- Wolfe Dental PLLC
All providers in Springfield, VT · Child & Adolescent Psychiatry Physician in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.