Provider Demographics
NPI:1063549244
Name:KNEISEL, PAMELA JOAN (PHD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JOAN
Last Name:KNEISEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 S. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:VT
Mailing Address - Zip Code:05075
Mailing Address - Country:US
Mailing Address - Phone:603-643-5253
Mailing Address - Fax:
Practice Address - Street 1:53 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:VT
Practice Address - Zip Code:05075
Practice Address - Country:US
Practice Address - Phone:603-643-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH388103TC0700X
VT587103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0608036YONH01OtherANTHEM
NH0608036YONH01OtherANTHEM