Provider Demographics
NPI:1346330883
Name:HOVER, JEANNE ANTHONY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:ANTHONY
Last Name:HOVER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:TONI
Other - Middle Name:
Other - Last Name:HOVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:SOUTH ROYALTON
Mailing Address - State:VT
Mailing Address - Zip Code:05068-0621
Mailing Address - Country:US
Mailing Address - Phone:802-763-2121
Mailing Address - Fax:
Practice Address - Street 1:79 SO. WINDSOR ST ON THE GREEN
Practice Address - Street 2:
Practice Address - City:SO. ROYALTON
Practice Address - State:VT
Practice Address - Zip Code:05068-0621
Practice Address - Country:US
Practice Address - Phone:802-763-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT080-00002091041C0700X
NH3821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ053973000OtherMAGELLAN BEHAVIORAL HEALT
VT9322OtherBLUE CROSS/BLUE SHIELD
MN1088369OtherCIGNA BEHAVIORAL HEALTH
VT1007146Medicaid