Healthcare Provider Details

I. General information

NPI: 1740687011
Provider Name (Legal Business Name): GUY BERNARD DEBROS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 SHIELDS DR
BENNINGTON VT
05201-9810
US

IV. Provider business mailing address

357 SHIELDS DR
BENNINGTON VT
05201-9810
US

V. Phone/Fax

Practice location:
  • Phone: 802-447-1409
  • Fax: 802-442-5199
Mailing address:
  • Phone: 802-447-1409
  • Fax: 802-442-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number048.0119755
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: