Provider Demographics
NPI:1225165020
Name:BAER, JEANNE (LICSW)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:BAER
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 1:31 PIERCE LN
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-9626
Mailing Address - Country:US
Mailing Address - Phone:802-649-9095
Mailing Address - Fax:802-649-2288
Practice Address - Street 1:31 PIERCE LN
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:VT
Practice Address - Zip Code:05055-9626
Practice Address - Country:US
Practice Address - Phone:802-649-9095
Practice Address - Fax:802-649-2288
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00005461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT29361OtherBCBSVERMONT NUMBER