Provider Demographics
NPI:1629282876
Name:BURROUS, CARRIE EMMA (PHD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:EMMA
Last Name:BURROUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:C
Other - Middle Name:EMMA
Other - Last Name:BURROUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:118 PINE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8421
Mailing Address - Country:US
Mailing Address - Phone:802-657-4042
Mailing Address - Fax:802-862-4062
Practice Address - Street 1:118 PINE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8421
Practice Address - Country:US
Practice Address - Phone:802-657-4042
Practice Address - Fax:802-862-4062
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0480000905103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical