Healthcare Provider Details

I. General information

NPI: 1629282876
Provider Name (Legal Business Name): CARRIE EMMA BURROUS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: C EMMA BURROUS PH.D.

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 PINE ST
BURLINGTON VT
05401-8421
US

IV. Provider business mailing address

118 PINE ST
BURLINGTON VT
05401-8421
US

V. Phone/Fax

Practice location:
  • Phone: 802-657-4042
  • Fax: 802-862-4062
Mailing address:
  • Phone: 802-657-4042
  • Fax: 802-862-4062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0480000905
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: