Healthcare Provider Details

I. General information

NPI: 1982940318
Provider Name (Legal Business Name): ROSE BARAN COLLETTI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE FLETCHER ALLEN HEALTH CARE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE FLETCHER ALLEN HEALTH CARE
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-8400
  • Fax: 802-847-5618
Mailing address:
  • Phone: 802-847-8400
  • Fax: 802-847-5618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number048.0000039
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number013631-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: