Provider Demographics
NPI:1043385156
Name:DEMAGGIO, ALLYSON GAIL (LICSW)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:GAIL
Last Name:DEMAGGIO
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 1:174 BATTERY ST
Mailing Address - Street 2:4
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-6201
Mailing Address - Country:US
Mailing Address - Phone:802-658-7708
Mailing Address - Fax:
Practice Address - Street 1:174 BATTERY ST
Practice Address - Street 2:4
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-6201
Practice Address - Country:US
Practice Address - Phone:802-658-7708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00006241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical