Provider Demographics
NPI:1003917857
Name:STETSON, FELIPE (LICSW)
Entity Type:Individual
Prefix:MR
First Name:FELIPE
Middle Name:
Last Name:STETSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ELM ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2865
Mailing Address - Country:US
Mailing Address - Phone:802-733-1827
Mailing Address - Fax:
Practice Address - Street 1:120 ELM ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2865
Practice Address - Country:US
Practice Address - Phone:802-733-1827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1136011041C0700X
VT089-00011511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013096Medicaid