Provider Demographics
NPI:1609416973
Name:MISAVAGE, MARY ELIZABETH (MSW LMSW LICSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:MISAVAGE
Suffix:
Gender:F
Credentials:MSW LMSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 RIVER STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2226
Mailing Address - Country:US
Mailing Address - Phone:802-886-4500
Mailing Address - Fax:802-886-4560
Practice Address - Street 1:49 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:VT
Practice Address - Zip Code:05047-0709
Practice Address - Country:US
Practice Address - Phone:802-295-3031
Practice Address - Fax:802-295-0820
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0134691101YP2500X
VT156.01339031041C0700X
VT089.01346211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional