Provider Demographics
NPI:1578572822
Name:BARSS, MARY BROOKE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BROOKE
Last Name:BARSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 LOOMIS ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3337
Mailing Address - Country:US
Mailing Address - Phone:802-951-9101
Mailing Address - Fax:801-951-9102
Practice Address - Street 1:222 LOOMIS ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3337
Practice Address - Country:US
Practice Address - Phone:802-951-9101
Practice Address - Fax:801-951-9102
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00076842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT8058OtherBC/BS
VT8058OtherBC/BS
VTVT9654Medicare ID - Type Unspecified