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General NPI Number Information
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NPI Number | 1730185232
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Entity Type | Organization
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Legal Business Name | BRATTLEBORO RETREAT
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 22 ANNA MARSH LANE
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City | BRATTLEBORO
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State | VT
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Zip | 05302-0803
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Country | US
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Telephone | 802-257-7785
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Fax | 802-258-3723
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Provider Business Mailing Address
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Address Line | PO BOX 101
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City | BRATTLEBORO
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State | VT
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Zip | 05302-0101
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Country | US
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Telephone | 802-257-7785
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Fax | 802-258-3798
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Authorized Official
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Title or Position | STAFF
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Name | AUTUMN KENDALL
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Credential |
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Telephone | 802-258-4310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 649
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License Number State | VT
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