Provider Demographics
NPI:1629015938
Name:HUNTER, ANYA RAVEN (LICSW)
Entity Type:Individual
Prefix:
First Name:ANYA
Middle Name:RAVEN
Last Name:HUNTER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WILDER ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3562
Mailing Address - Country:US
Mailing Address - Phone:802-229-0399
Mailing Address - Fax:
Practice Address - Street 1:172 BERLIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3566
Practice Address - Country:US
Practice Address - Phone:802-229-0399
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00007961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009234Medicaid
VT1009234Medicaid