Provider Demographics
NPI:1669501045
Name:BARR, SAMANTHA (PSYD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BARR
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 953
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477-0953
Mailing Address - Country:US
Mailing Address - Phone:802-881-6195
Mailing Address - Fax:802-881-6195
Practice Address - Street 1:183 TALCOTT RD
Practice Address - Street 2:SUITE 206
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-2089
Practice Address - Country:US
Practice Address - Phone:802-881-6195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0480000926174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT11883762OtherCAQH
VT1015547Medicaid