Provider Demographics
NPI:1275698649
Name:BOUTSIKARIS, BARBARA FANNIE (MS, LCMHC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:FANNIE
Last Name:BOUTSIKARIS
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8512
Mailing Address - Country:US
Mailing Address - Phone:802-310-6492
Mailing Address - Fax:802-658-7999
Practice Address - Street 1:2 CHURCH ST
Practice Address - Street 2:SUITE 4G
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4299
Practice Address - Country:US
Practice Address - Phone:802-658-7999
Practice Address - Fax:802-658-7999
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000211101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health