Provider Demographics
NPI:1497817324
Name:VAN DRIMMELEN, BARBARA (PSYD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:VAN DRIMMELEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1074
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-1074
Mailing Address - Country:US
Mailing Address - Phone:802-860-2202
Mailing Address - Fax:
Practice Address - Street 1:444 S UNION ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4859
Practice Address - Country:US
Practice Address - Phone:802-985-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0000558103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT69187OtherBCBS OF VT
VT90595OtherCIGNA BEHAVIORAL HEALTH
VT057393385OtherUBH
VT1003818Medicaid
VT1003818Medicaid
VT057393385OtherUBH