Vermont Psychological Services: Leitenberg Center for Evidence-Based P

Organization Active NPI Clinical Psychologist · Burlington, VT

NPI 1598837593 · NPPES record last updated Feb 3, 2017

Key facts

NPI
1598837593
Entity type
Organization (NPI type 2)
Primary specialty
Clinical Psychologist 103TC0700X
Legal business name
VERMONT PSYCHOLOGICAL SERVICES: LEITENBERG CENTER FOR EVIDENCE-BASED P
Practice address
2 Colchester Avenue
Burlington, VT 05405-1764
Phone
(802) 656-2661
Fax
(802) 656-3485
NPI assigned
Nov 14, 2006
Organization subpart
No

Authorized official

Name
Kathleen B. Kennedy, PH.D. NPI 1902857048
Title
Acting Director
Phone
(802) 656-2661

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 45

Medicare participation

Medicare fee-for-service enrollment
Enrolled in VT

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20050411000605 VT Part B Supplier - Clinic/Group Practice 0244277333 Receives reassigned benefits from 2 practitioners
Practice locations: Burlington, VT

National Provider Directory

Locations

2 Colchester Ave
Burlington, VT 05405
Phone (802) 656-2661

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist
Group: 193400000X SINGLE SPECIALTY GROUP
103TC0700X Yes

Addresses

Primary practice location

2 Colchester Avenue
Burlington, VT 05405-1764

Mailing address

2 Colchester Avenue
Burlington, VT 05405-1764
Phone (802) 656-2661

Other identifiers

IdentifierTypeStateIssuer
2820OtherVTBCBS OF VT
2820OtherVTBCBS
0002820MedicaidVT

Other names

  • Behavior Therapy & Psychotherapy Center Inc Former legal business name

Other providers in Burlington, VT

All providers in Burlington, VT · Clinical Psychologist in Vermont

Sources for this page

Verify at the official NPI Registry.