1619931300 NPI number — MS. DALENE M WASHBURN LICSW

Table of content: MS. DALENE M WASHBURN LICSW (NPI 1619931300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619931300 NPI number — MS. DALENE M WASHBURN LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASHBURN
Provider First Name:
DALENE
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619931300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 PLEASANT ST
Provider Second Line Business Mailing Address:
VERMONT CHILDREN'S AID SOCIETY, SIMMONS BUILDING
Provider Business Mailing Address City Name:
WOODSTOCK
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05091-1122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-457-3084
Provider Business Mailing Address Fax Number:
802-457-3086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 PLEASANT ST
Provider Second Line Business Practice Location Address:
VERMONT CHILDREN'S AID SOCIETY, SIMMONS BUILDING
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05091-1122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-457-3084
Provider Business Practice Location Address Fax Number:
802-457-3086
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  089-0000386 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 381295 . This is a "MVP HEALTH INSURANCE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 2017823 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30420716 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18947 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1006819 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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