Healthcare Provider Details

I. General information

NPI: 1063547537
Provider Name (Legal Business Name): LYDIA M BARNES MA LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYDIA GRIMES

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 FAIRVIEW STREET
BRATTLEBORO VT
05301-6629
US

IV. Provider business mailing address

390 RIVER STREET
SPRINGFIELD VT
05156-2226
US

V. Phone/Fax

Practice location:
  • Phone: 802-254-6028
  • Fax: 802-254-7501
Mailing address:
  • Phone: 802-886-4500
  • Fax: 802-886-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0090295
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number097.0094257
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: