Provider Demographics
NPI:1932255833
Name:BARRON, HENRY (LADC)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:BARRON
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 TWIN POND RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05036-9540
Mailing Address - Country:US
Mailing Address - Phone:802-276-3929
Mailing Address - Fax:
Practice Address - Street 1:2224 TWIN POND RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:VT
Practice Address - Zip Code:05036-9540
Practice Address - Country:US
Practice Address - Phone:802-276-3929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMH0079OtherBCBS OF MA
VT59366OtherBCBS OF VT