Healthcare Provider Details

I. General information

NPI: 1184747339
Provider Name (Legal Business Name): BRADFORD PSYCHIATRIC ASSOCIATES. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 STRATTON RD STE 1
RUTLAND VT
05701-4892
US

IV. Provider business mailing address

199 STRATTON RD STE 1
RUTLAND VT
05701-4892
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-7798
  • Fax: 802-775-7762
Mailing address:
  • Phone: 802-775-7798
  • Fax: 802-775-7762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LEE LAUGHLIN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 802-775-7798