Provider Demographics
NPI:1013962315
Name:BANDMAN, BERNARD M (PHD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:M
Last Name:BANDMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BENMONT AVE
Mailing Address - Street 2:PO BOX 1129
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-1873
Mailing Address - Country:US
Mailing Address - Phone:802-447-0037
Mailing Address - Fax:802-442-8721
Practice Address - Street 1:160 BENMONT AVE
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1873
Practice Address - Country:US
Practice Address - Phone:802-447-0037
Practice Address - Fax:802-442-8721
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000008103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002831Medicaid
VT41805OtherMOHAWK VALLEY PLAN
VT2831OtherBLUE CROSS
VT1018438OtherCIGNA
VTA097300OtherCDPHP
VT0007270183OtherAETNA
VT0002831Medicaid