Montgomery-Logan, Diane

Montgomery-Logan, Diane is an sole proprietor health care provider with primary practice located at 99 Hall St , Winooski VT 05404-1738. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Group Psychotherapy. Behavioral Health & Social Service Providers / Psychologist is her primary health care specialty. Montgomery-Logan, Diane can be contacted via phone (802) 860-9500.

Contact Information

Primary practice address
99 Hall St Winooski VT 05404-1738
Phone: (802) 860-9500
Fax: (802) 655-3963
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 534 Vermont
Behavioral Health & Social Service Providers / Group Psychotherapy 103TP2701X 534 Vermont

Profile Details

NPI number 1962504183
LBN Legal business name Montgomery-Logan, Diane
Credentials Master of Arts (MA)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 1st, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962504183 NPPES
Vermont MEDICAID 1004148

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