Provider Demographics
NPI:1275957805
Name:PLUMLEY, DEIDRE (LICSW, LADC)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:PLUMLEY
Suffix:
Gender:F
Credentials:LICSW, LADC
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 152
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:VT
Mailing Address - Zip Code:05820-0152
Mailing Address - Country:US
Mailing Address - Phone:802-487-5053
Mailing Address - Fax:
Practice Address - Street 1:101 WATER ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:VT
Practice Address - Zip Code:05820-2017
Practice Address - Country:US
Practice Address - Phone:802-487-5053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09100901041C0700X, 1041C0700X
VT089.01344071041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1336163963Medicaid