Provider Demographics
NPI:1083808992
Name:BAUMGARDNER, GRETCHEN HOLLY X (LICSW)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:HOLLY
Last Name:BAUMGARDNER
Suffix:X
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 1:45 STATE ST.
Mailing Address - Street 2:P.O. BOX 2100
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-2100
Mailing Address - Country:US
Mailing Address - Phone:802-229-2562
Mailing Address - Fax:
Practice Address - Street 1:58 COLLEGE ST
Practice Address - Street 2:#1
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3115
Practice Address - Country:US
Practice Address - Phone:802-229-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00008741041C0700X
VT08900008741041S0200X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator