Provider Demographics
NPI:1093883365
Name:GURNEY, CHARLES RICHARD (LICSW, LADC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RICHARD
Last Name:GURNEY
Suffix:
Gender:M
Credentials:LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:ISLE LA MOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05463-0093
Mailing Address - Country:US
Mailing Address - Phone:802-379-4286
Mailing Address - Fax:
Practice Address - Street 1:31 MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8407
Practice Address - Country:US
Practice Address - Phone:802-379-4286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-0000306101YM0800X
VT000094101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN0754Medicaid
VT19092OtherVT BCBS PIN NUMBER
VT2029811OtherCIGNA PIN NUMBER
VT933840OtherMAGELLAN PIN NUMBER
VT217818OtherMHN PIN NUMBER
VT1100004Medicaid
VT45605OtherMBC VT PIN NUMBER
VT093706OtherVALUE OPTIONS PIN
VT61167OtherMVP PIN NUMBER
VTGUVN0754Medicare PIN