Provider Demographics
NPI:1770658072
Name:BARRY, RAE ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAE ANNE
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5138 SHELBURNE RD
Mailing Address - Street 2:PO BOX 367
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6698
Mailing Address - Country:US
Mailing Address - Phone:802-985-3315
Mailing Address - Fax:
Practice Address - Street 1:5138 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6698
Practice Address - Country:US
Practice Address - Phone:802-985-3315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1002298Medicaid
VT5665OtherBCBSVT
VT1002298Medicaid