Provider Demographics
NPI:1417490186
Name:MEGAS-RUSSELL, EMILY LOUISE (LICSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LOUISE
Last Name:MEGAS-RUSSELL
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 1:1478 HINESBURG RD
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-8997
Mailing Address - Country:US
Mailing Address - Phone:802-689-0715
Mailing Address - Fax:
Practice Address - Street 1:1478 HINESBURG RD
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-8997
Practice Address - Country:US
Practice Address - Phone:802-689-0715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00730071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical