Provider Demographics
NPI:1225059751
Name:GREGORY, PEGGY SHEEHAN (LICSW)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:SHEEHAN
Last Name:GREGORY
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 65
Mailing Address - Street 2:
Mailing Address - City:DORSET
Mailing Address - State:VT
Mailing Address - Zip Code:05251-0065
Mailing Address - Country:US
Mailing Address - Phone:802-379-8517
Mailing Address - Fax:
Practice Address - Street 1:3556 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05254-0525
Practice Address - Country:US
Practice Address - Phone:802-379-8517
Practice Address - Fax:802-332-3778
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-0000359103T00000X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
359508OtherMANAGED HEALTH NET
1041590OtherCIGNA
VT1007299Medicaid
38184OtherBLUE CROSS
359508OtherMANAGED HEALTH NET
38184OtherBLUE CROSS
VT1007299Medicaid