Healthcare Provider Details

I. General information

NPI: 1457667503
Provider Name (Legal Business Name): BPS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 OLD FARM RD
STOWE VT
05672-4434
US

IV. Provider business mailing address

56 OLD FARM RD
STOWE VT
05672-4434
US

V. Phone/Fax

Practice location:
  • Phone: 802-373-2909
  • Fax:
Mailing address:
  • Phone: 802-373-2909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number860
License Number StateVT

VIII. Authorized Official

Name: DR. RICHARD T BARNETT
Title or Position: OWNER
Credential: PSY.D.
Phone: 802-373-2909