Provider Demographics
NPI:1598837593
Name:VERMONT PSYCHOLOGICAL SERVICES: LEITENBERG CENTER FOR EVIDENCE-BASED P
Entity Type:Organization
Organization Name:VERMONT PSYCHOLOGICAL SERVICES: LEITENBERG CENTER FOR EVIDENCE-BASED P
Other - Org Name:BEHAVIOR THERAPY & PSYCHOTHERAPY CENTER INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ACTING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:802-656-2661
Mailing Address - Street 1:2 COLCHESTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05405-1764
Mailing Address - Country:US
Mailing Address - Phone:802-656-2661
Mailing Address - Fax:802-656-3485
Practice Address - Street 1:2 COLCHESTER AVENUE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05405-1764
Practice Address - Country:US
Practice Address - Phone:802-656-2661
Practice Address - Fax:802-656-3485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT2820OtherBCBS OF VT
VT2820OtherBCBS
VT0002820Medicaid
VT2820OtherBCBS
VT2820Medicare UPIN