Provider Demographics
NPI:1225491244
Name:MICHAEL J. RICHARDS-BRADT, LLC
Entity Type:Organization
Organization Name:MICHAEL J. RICHARDS-BRADT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST-MASTER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARDS-BRADT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:802-497-1920
Mailing Address - Street 1:1233 SHELBURNE RD STE 360
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7752
Mailing Address - Country:US
Mailing Address - Phone:802-497-1920
Mailing Address - Fax:802-860-1625
Practice Address - Street 1:1233 SHELBURNE RD STE 360
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7752
Practice Address - Country:US
Practice Address - Phone:802-497-1920
Practice Address - Fax:802-860-1625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047.0098988103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty