Provider Demographics
NPI:1043801814
Name:BARNETT, AUTUMN (LICSW)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:BARNETT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BEARTOWN LN
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-9673
Mailing Address - Country:US
Mailing Address - Phone:802-622-1131
Mailing Address - Fax:
Practice Address - Street 1:116 BEARTOWN LN
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-9673
Practice Address - Country:US
Practice Address - Phone:802-622-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01343651041C0700X
VT097.01331651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical