Active NPI
Scott J Burg, M.A.
- Clinical Psychologist
- Bennington, VT
National Provider Identifier
1376086280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 097.0103158
- Practice address
- 160 Benmont Ave
Suite C3-95
Bennington, VT 05201-1873 - Phone
- (802) 379-2496
- NPI assigned
- Nov 24, 2016
- Last updated
- Nov 24, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 097.0103158 | VT | Primary |
Addresses
Primary practice location
160 Benmont Ave
Suite C3-95
Bennington, VT 05201-1873
Mailing address
160 Benmont Ave
Suite C3-95
Bennington, VT 05201-1873
Phone (802) 379-2496
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 097.0103158 | VT | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1479945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479945600000",
"number": "1376086280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 BENMONT AVE",
"address_2": "SUITE C3-95",
"city": "BENNINGTON",
"state": "VT",
"postal_code": "052011873",
"telephone_number": "802-379-2496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 BENMONT AVE",
"address_2": "SUITE C3-95",
"city": "BENNINGTON",
"state": "VT",
"postal_code": "052011873",
"telephone_number": "802-379-2496"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURG",
"first_name": "SCOTT",
"middle_name": "J",
"credential": "M.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-11-24",
"last_updated": "2016-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VT",
"license": "097.0103158",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bennington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.