Provider Demographics
NPI:1043390339
Name:MARKLAND, SHIRLEY (LICSW)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:MARKLAND
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 1:15 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:VT
Mailing Address - Zip Code:05733-1127
Mailing Address - Country:US
Mailing Address - Phone:802-247-8504
Mailing Address - Fax:
Practice Address - Street 1:7 COURT SQ
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4030
Practice Address - Country:US
Practice Address - Phone:802-775-4388
Practice Address - Fax:802-775-3307
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900006951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1895Medicaid
VT00039279OtherBCBS
VTVN1895Medicare ID - Type Unspecified