Provider Demographics
NPI:1497804256
Name:LANSBURY, TASHA CORNELL (LICSW)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:CORNELL
Last Name:LANSBURY
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 1:156 COLLEGE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8423
Mailing Address - Country:US
Mailing Address - Phone:802-651-7676
Mailing Address - Fax:802-860-0183
Practice Address - Street 1:156 COLLEGE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8423
Practice Address - Country:US
Practice Address - Phone:802-651-7676
Practice Address - Fax:802-860-0183
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00007471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT61408OtherMVP SELECT CARE
VT73382OtherMVP PRIMARILINK
VT1007459Medicaid