Provider Demographics
NPI:1477023372
Name:NYDEGGER, MAURA (LICSW, MSW)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:NYDEGGER
Suffix:
Gender:F
Credentials:LICSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 MAIN ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:VT
Mailing Address - Zip Code:05770-8807
Mailing Address - Country:US
Mailing Address - Phone:802-349-8579
Mailing Address - Fax:
Practice Address - Street 1:199 MAIN ST UNIT C
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:VT
Practice Address - Zip Code:05770-8807
Practice Address - Country:US
Practice Address - Phone:802-349-8579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00952561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical