Provider Demographics
NPI:1255465100
Name:LINE-ANDREWS, ALLISON JEAN (LICSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:JEAN
Last Name:LINE-ANDREWS
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 1:4628 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05051-6044
Mailing Address - Country:US
Mailing Address - Phone:802-274-5120
Mailing Address - Fax:
Practice Address - Street 1:4628 MAIN ST.
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:VT
Practice Address - Zip Code:05051-6044
Practice Address - Country:US
Practice Address - Phone:802-274-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12011041C0700X
VT089.00777171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical