1255439337 NPI number — BARBARA SUE KLEINMAN LICSW

Table of content: BARBARA SUE KLEINMAN LICSW (NPI 1255439337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255439337 NPI number — BARBARA SUE KLEINMAN LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEINMAN
Provider First Name:
BARBARA
Provider Middle Name:
SUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255439337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
47 SANDY LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-264-5333
Provider Business Mailing Address Fax Number:
802-264-5338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 HERCULES DRIVE
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
COLCHESTER
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-264-5333
Provider Business Practice Location Address Fax Number:
802-264-5338
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  089-0000957 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4123889 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 059594690 . This is a "CIGNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1009981 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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