Provider Demographics
NPI:1407194657
Name:BARCLAY, DIANNE RICHOZ (LAC)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:RICHOZ
Last Name:BARCLAY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4020
Mailing Address - Country:US
Mailing Address - Phone:802-342-4880
Mailing Address - Fax:
Practice Address - Street 1:105 CENTER ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4020
Practice Address - Country:US
Practice Address - Phone:802-342-4880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091.0087912171100000X
NY004862171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist