Provider Demographics
NPI:1407937881
Name:STRAW, GAIL MARIE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:MARIE
Last Name:STRAW
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 1:22 ADIRONDACK ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7233
Mailing Address - Country:US
Mailing Address - Phone:802-660-8914
Mailing Address - Fax:
Practice Address - Street 1:148 COLLEGE ST
Practice Address - Street 2:STE 303
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8476
Practice Address - Country:US
Practice Address - Phone:802-985-2346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900005371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006839Medicaid
VT1006839Medicaid