Individual
BARRY N WATERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYA.D.
Contact information
Practice address
331 UPPER PLN, BRADFORD, VT 05033
(802) 272-0075
Mailing address
PO BOX 369, BRADFORD, VT 05033-0369
(802) 272-0075
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
048.0122895
VT
103TP0814X
Psychoanalysis Psychologist
098-0000177
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006572
—
VT
01
—
0626572
BCBS OF VERMONT
VT
05
—
30007402
—
NH
Enumeration date
11/15/2006
Last updated
09/20/2021
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