Provider Demographics
NPI:1164600649
Name:PARKER, CHRISTINE E (LICSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:PARKER
Suffix:
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:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-0647
Mailing Address - Country:US
Mailing Address - Phone:802-229-0591
Mailing Address - Fax:802-223-3667
Practice Address - Street 1:286 HOSPITAL LOOP
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9523
Practice Address - Country:US
Practice Address - Phone:802-229-0591
Practice Address - Fax:802-223-3667
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00012241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1014625Medicaid
2667970OtherCIGNA
VT989026COtherMVP
VT1164600649OtherBLUE CROSS/BLUE SHIELD OF VERMONT
415782OtherTRICARE
VT000461801Medicare PIN