Provider Demographics
NPI:1477574036
Name:WILSON, MAUREEN CLAIRE (LICSW)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:CLAIRE
Last Name:WILSON
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:PO BOX 547
Mailing Address - Street 2:CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-225-1266
Mailing Address - Fax:802-479-3548
Practice Address - Street 1:82 E VIEW LN STE 3
Practice Address - Street 2:FAMILY PSYCHIATRY ASSOCIATES
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-225-1266
Practice Address - Fax:802-479-3548
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00002131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2452Medicaid
VTVN24501Medicare PIN
VN2452Medicare ID - Type Unspecified