Active NPI
Mary Willmuth, PH.D.
- Clinical Psychologist
- Burlington, VT
National Provider Identifier
1821190380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- Practice address
- 86 Lake St
Burlington, VT 05401-5297 - Phone
- (802) 865-3450
- NPI assigned
- Sep 3, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | VT | Primary |
Addresses
Primary practice location
86 Lake St
Burlington, VT 05401-5297
Mailing address
86 Lake St
Burlington, VT 05401-5297
Phone (802) 865-3450
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0009087 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 048-000355 | VT | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1821190380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "86 LAKE ST",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "054015297",
"telephone_number": "802-865-3450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "86 LAKE ST",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "054015297",
"telephone_number": "802-865-3450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLMUTH",
"first_name": "MARY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VT",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0009087",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burlington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.