Provider Demographics
NPI:1275874802
Name:BIRGE, NANCY B (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:B
Last Name:BIRGE
Suffix:
Gender:F
Credentials:MSW, 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 842
Mailing Address - Street 2:
Mailing Address - City:WILDER
Mailing Address - State:VT
Mailing Address - Zip Code:05088-0842
Mailing Address - Country:US
Mailing Address - Phone:802-226-7217
Mailing Address - Fax:
Practice Address - Street 1:2458 CHRISTIAN ST
Practice Address - Street 2:SUITE 214
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-9855
Practice Address - Country:US
Practice Address - Phone:802-356-9393
Practice Address - Fax:802-356-9393
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00012531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical