Provider Demographics
NPI:1558489914
Name:LINES, AMY JO (LICSW)
Entity Type:Individual
Prefix:
First Name:AMY JO
Middle Name:
Last Name:LINES
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 1:1 HOSPITAL CT
Mailing Address - Street 2:STE 410
Mailing Address - City:BELLOWS FALLS
Mailing Address - State:VT
Mailing Address - Zip Code:05101-1489
Mailing Address - Country:US
Mailing Address - Phone:802-463-3294
Mailing Address - Fax:802-463-1206
Practice Address - Street 1:107 PARK ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-3028
Practice Address - Country:US
Practice Address - Phone:802-885-5781
Practice Address - Fax:802-885-4851
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-0000245103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist