Provider Demographics
NPI:1144615816
Name:LEE, AVERY (MSW)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3042 VT ROUTE 109
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05492-9531
Mailing Address - Country:US
Mailing Address - Phone:802-829-0066
Mailing Address - Fax:
Practice Address - Street 1:156 COLLEGE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8423
Practice Address - Country:US
Practice Address - Phone:802-651-7674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01074401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical