=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497404438
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAROODY COUNSELING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2022
-----------------------------------------------------
Last Update Date | 03/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 77 GROVE ST STE 107
-----------------------------------------------------
City | RUTLAND
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05701-3403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-379-9675
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 187 COUNTRYSIDE DR
-----------------------------------------------------
City | RUTLAND
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05701-9313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-312-9781
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | MRS. KATHLEEN E BAROODY
-----------------------------------------------------
Credential | LCMHC, NCC
-----------------------------------------------------
Telephone | 407-312-9781
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------