Provider Demographics
NPI:1336685809
Name:BUELTER, ELLIOTT (LICSW)
Entity Type:Individual
Prefix:MR
First Name:ELLIOTT
Middle Name:
Last Name:BUELTER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:MR
Other - First Name:ELLIOTT
Other - Middle Name:
Other - Last Name:BUELTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:156 JOHNSON STREET EXT
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:VT
Mailing Address - Zip Code:05655-9354
Mailing Address - Country:US
Mailing Address - Phone:401-714-4930
Mailing Address - Fax:401-712-8659
Practice Address - Street 1:156 JOHNSON STREET EXT
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:VT
Practice Address - Zip Code:05655-9354
Practice Address - Country:US
Practice Address - Phone:802-851-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01343001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6705170Medicaid