=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154840718
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A. KEITH BARTON, PHD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2017
-----------------------------------------------------
Last Update Date | 09/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 146 DANBURY RD STE D
-----------------------------------------------------
City | NEW MILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06776-3427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-773-8837
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 146 DANBURY RD STE D
-----------------------------------------------------
City | NEW MILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06776-3427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | ALTON K BARTON
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 281-773-8837
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 3670
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------