Provider Demographics
NPI:1588829972
Name:WELLS, BEATRICE M (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:BEATRICE
Middle Name:M
Last Name:WELLS
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 1:24 1/2 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4041
Mailing Address - Country:US
Mailing Address - Phone:802-773-3379
Mailing Address - Fax:802-773-7550
Practice Address - Street 1:24 1/2 CENTER ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4041
Practice Address - Country:US
Practice Address - Phone:802-773-3379
Practice Address - Fax:802-773-7550
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00012561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical