Provider Demographics
NPI:1235536400
Name:LEWELLEN, MEGHAN (LICSW)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:LEWELLEN
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 1:4 MERRILL LN
Mailing Address - Street 2:UNIT 102
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-3322
Mailing Address - Country:US
Mailing Address - Phone:802-922-1551
Mailing Address - Fax:
Practice Address - Street 1:4 MERRILL LN
Practice Address - Street 2:UNIT 102
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3322
Practice Address - Country:US
Practice Address - Phone:802-922-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00975081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical