Provider Demographics
NPI:1497141063
Name:BILLIE FAIRBROTHER, LICSW, LLC
Entity Type:Organization
Organization Name:BILLIE FAIRBROTHER, LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BILLIE JO
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRBROTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-246-1221
Mailing Address - Street 1:36 PARK PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-2802
Mailing Address - Country:US
Mailing Address - Phone:802-246-1221
Mailing Address - Fax:802-246-1002
Practice Address - Street 1:36 PARK PL
Practice Address - Street 2:SUITE 101
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-2802
Practice Address - Country:US
Practice Address - Phone:802-246-1221
Practice Address - Fax:802-246-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0890101573101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty