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General NPI Number Information
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NPI Number | 1275698649
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Entity Type | Individual
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Provider Name | BARBARA FANNIE BOUTSIKARIS MS, LCMHC
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Gender | Female
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2 CHURCH ST SUITE 4G
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City | BURLINGTON
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State | VT
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Zip | 05401-4299
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Country | US
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Telephone | 802-658-7999
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Fax | 802-658-7999
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Provider Business Mailing Address
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Address Line | 63 GREEN ST
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City | BURLINGTON
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State | VT
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Zip | 05401-8512
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Country | US
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Telephone | 802-310-6492
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Fax | 802-658-7999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 068-0000211
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License Number State | VT
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