Healthcare Provider Details

I. General information

NPI: 1992766497
Provider Name (Legal Business Name): BETSY J BARRETT LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 HAYNES ST
MANCHESTER CT
06040-4131
US

IV. Provider business mailing address

153 EASTERN DR
MIDDLETOWN CT
06457-3915
US

V. Phone/Fax

Practice location:
  • Phone: 860-646-1222
  • Fax: 860-533-3452
Mailing address:
  • Phone: 860-966-2673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000719
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: