Provider Demographics
NPI:1043893498
Name:STAFFO, CHRISTINE L (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:L
Last Name:STAFFO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:L
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2288 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:WEST HALIFAX
Mailing Address - State:VT
Mailing Address - Zip Code:05358-7985
Mailing Address - Country:US
Mailing Address - Phone:802-368-7869
Mailing Address - Fax:
Practice Address - Street 1:2288 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:WEST HALIFAX
Practice Address - State:VT
Practice Address - Zip Code:05358-7985
Practice Address - Country:US
Practice Address - Phone:802-368-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01341651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical