Provider Demographics
NPI:1093208423
Name:VAN WINKLE, GRETCHEN L (LICSW)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:L
Last Name:VAN WINKLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:L
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:390 RIVER STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2226
Mailing Address - Country:US
Mailing Address - Phone:802-886-4500
Mailing Address - Fax:802-886-4520
Practice Address - Street 1:49 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:VT
Practice Address - Zip Code:05047
Practice Address - Country:US
Practice Address - Phone:802-295-3031
Practice Address - Fax:802-295-8020
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH25991041C0700X
VT089.01209971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical