Provider Demographics
NPI:1275312704
Name:HATHAWAY-MIGLORIE, ANDREA (LICSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:HATHAWAY-MIGLORIE
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 1:78 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4594
Mailing Address - Country:US
Mailing Address - Phone:802-775-8224
Mailing Address - Fax:802-747-7699
Practice Address - Street 1:98 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4776
Practice Address - Country:US
Practice Address - Phone:802-747-3588
Practice Address - Fax:802-747-3699
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.01354751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical