47D0987230 CLIA NUMBER - MEMORY CLINIC,THE

Laboratory Demographics

CLIA Number: 47D0987230

Facility Name: MEMORY CLINIC,THE

Facility Address:
357 SHIELDS DRIVE
BENNINGTON, VT
ZIP 05201
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Facility Phone Number: 802 447-1409

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1205359213

Taxonomy: 2084B0040X - Psychiatry & Neurology
Behavioral Neurology & Neuropsychiatry is a medical subspecialty involving the diagnosis and treatment of neurologically based behavioral issues.

CLIA Record

Field Name	Field Value
CLIA Number	47D0987230
LAB Type	Other
Facility Name	MEMORY CLINIC,THE
Street	357 SHIELDS DRIVE
City	BENNINGTON
State	VT
ZIP	05201
Phone	802 447-1409
CertificateType	4
CertificateEffectiveDate	5/31/2023
CertificateExpirationDate	5/30/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024